| Certificate Number | 50 | | Date Issued |
| Child Given Name | Marcellus H. |
Hicks | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 09 Nov 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Wm A. |
Hicks | Father's Surname |
| Father's Occupation | Teacher | | Father's Nationality |
| Father's Birth Place | Iowa | 31 | Father's Age |
| Mother's Given Name | Elizabeth | Gregory | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Rockville IN | Mother's Birth Place |
| Mother's Age | 32 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.L., Mrs. Bartlett | Ames IA | Medical Attendant's Address |