| Certificate Number | 592 | | Date Issued |
| Child Given Name | |
Kintsley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 Jul 1887 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm P. |
Kintsley | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Story Co IA | 27 | Father's Age |
| Mother's Given Name | Agnes E. | Hays | Mother's Maiden Name |
| Mother's Surname | | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 24 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |