| Certificate Number | 131 | | Date Issued |
| Child Given Name | Leonard Benjamin |
Harrison | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 23 Apr 1888 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Thomas |
Harrison | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 22 | Father's Age |
| Mother's Given Name | Dora L. | Palmatier | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A. Richmond | Ames IA | Medical Attendant's Address |