| Certificate Number | 53 | | Date Issued |
| Child Given Name | |
Kintsley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Dec 1888 |
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 | Iowa | 29 | Father's Age |
| Mother's Given Name | Nellie | Hayes | Mother's Maiden Name |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 26 | 4 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |