| Certificate Number | 105 | | Date Issued |
| Child Given Name | |
Ives | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 24 Mar 1890 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | David W. |
Ives | Father's Surname |
| Father's Occupation | Laborer | German | Father's Nationality |
| Father's Birth Place | Topeka KS | 23 | Father's Age |
| Mother's Given Name | Ella A. | Heacock | Mother's Maiden Name |
| Mother's Surname | | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 18 | 2 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |