| Certificate Number | 388 | | Date Issued |
| Child Given Name | Enos A. |
Kem | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 06 May 1882 |
Near Zearing Story Co IA | Place of Birth |
| Father's Given Name | Simon |
Kem | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 34 | Father's Age |
| Mother's Given Name | Lilian E. | Loop | Mother's Maiden Name |
| Mother's Surname | Kem | Near Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | A.W. Squires M.D. | | Medical Attendant's Address |
| Certificate Signer's Name | A.W. Squires M.D. | | Certificate Signer's Address |
| Returned by Name | A.W. Squires M.D. | | |