| Certificate Number | 580 | | Date Issued |
| Child Given Name | Seth Lewis |
Brooks | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Feb 1881 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | A.M. |
Brooks | Father's Surname |
| Father's Occupation | Physician | American | Father's Nationality |
| Father's Birth Place | Illinois | 35 | Father's Age |
| Mother's Given Name | Henrieta M. | Lewis | Mother's Maiden Name |
| Mother's Surname | Brooks | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 35 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Vandusen | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | Mrs. Vandusen | Zearing IA | Certificate Signer's Address |
| Returned by Name | A.M. Brooks | | |