| Certificate Number | 602 | | Date Issued |
| Child Given Name | William Henry |
Lynch | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Mar 1883 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Thomas |
Lynch | Father's Surname |
| Father's Occupation | Blacksmith | Irish | Father's Nationality |
| Father's Birth Place | Ireland | 37 | Father's Age |
| Mother's Given Name | Rosan | Dolan | Mother's Maiden Name |
| Mother's Surname | Lynch | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | American | Massachusets | Mother's Birth Place |
| Medical Attendant's Name | J. Daugherty | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | J. Daughtery | Colo IA | Certificate Signer's Address |
| Returned by Name | J. Daugherty | | |