| Certificate Number | 552 | | Date Issued |
| Child Given Name | |
Batterson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Jan 1883 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | James W. |
Batterson | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Connecticut | 49 | Father's Age |
| Mother's Given Name | Elizabeth | Kelley | Mother's Maiden Name |
| Mother's Surname | Batterson | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 37 | 8 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |