| Certificate Number | 54 | | Date Issued |
| Child Given Name | Iven |
Kingsbury | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 09 Dec 1889 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Chas. W. |
Kingsbury | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 24 | Father's Age |
| Mother's Given Name | Mary | Kyle | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |