| Certificate Number | 95 | | Date Issued |
| Child Given Name | |
Kiegley | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Feb 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | John J. |
Kiegly | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 39 | Father's Age |
| Mother's Given Name | Julie E. | Hinchey | Mother's Maiden Name |
| Mother's Surname | Kiegly | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 38 | 7 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |