| Certificate Number | 444 | | Date Issued |
| Child Given Name | |
Lefler | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Nov 1886 |
Gilbert Story Co IA | Place of Birth |
| Father's Given Name | E.D. |
Lefler | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 28 | Father's Age |
| Mother's Given Name | Mary | Howard | Mother's Maiden Name |
| Mother's Surname | Lefler | Gilbert Station Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 25 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | E.B. Plumb | Ames IA | Certificate Signer's Address |
| Returned by Name | E.B. Plumb | | |