| Certificate Number | 11 | | Date Issued |
| Child Given Name | |
Laughran | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 Oct 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | E.J. |
Laughran | Father's Surname |
| Father's Occupation | Salesman | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | May L. | Graves | Mother's Maiden Name |
| Mother's Surname | Loughran | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |