| Certificate Number | 335 | | Date Issued |
| Child Given Name | Lulu Amelia |
Buffington | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 22 Dec 1881 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | Isaac |
Buffington | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 43 | Father's Age |
| Mother's Given Name | Sarah A. | Fisher | Mother's Maiden Name |
| Mother's Surname | Buffington | Story County IA | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 41 | 9 | Number of Child This Mother |
| Medical Attendant's Name | J. Daughtery M.D. | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | J. Daughtery M.D. | Colo IA | Certificate Signer's Address |
| Returned by Name | J. Daughtery M.D. | | |