| Certificate Number | 461 | | Date Issued |
| Child Given Name | Frank Wallace |
Bales | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 Sep 1882 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | James Morgan |
Bales | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | | Father's Age |
| Mother's Given Name | Charlet E. | Brown | Mother's Maiden Name |
| Mother's Surname | Bales | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 1 | Number of Child This Mother |
| Medical Attendant's Name | S.C. Jessey | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | J.C. Jessey | Zearing IA | Certificate Signer's Address |
| Returned by Name | J.C. Jessey | | |