| Certificate Number | 492 | | Date Issued |
| Child Given Name | Osker Kelly |
Lansing | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 01 Nov 1882 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Robert Buce |
Lansing | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 29 | Father's Age |
| Mother's Given Name | Lucy K. | Kelley | Mother's Maiden Name |
| Mother's Surname | Lansing | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 25 | 7 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hayes M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes M.D. | | |