| Certificate Number | 220 | | Date Issued |
| Child Given Name | Orville A. |
Kuhn | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Sep 1888 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Cyrus A. |
Kuhn | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 28 | Father's Age |
| Mother's Given Name | Alice M. | Mead | Mother's Maiden Name |
| Mother's Surname | | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Canada | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |