| Certificate Number | 495 | | Date Issued |
| Child Given Name | Irvill |
Jones | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 07 Oct 1882 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Paul F. |
Jones | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 36 | Father's Age |
| Mother's Given Name | Sarah A. | McDaniels | Mother's Maiden Name |
| Mother's Surname | Jones | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 29 | 6 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merredith | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merredith | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merredith | | |