| Certificate Number | 121 | | Date Issued |
| Child Given Name | Ray Major |
Lightfoot | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 16 Apr 1890 |
Lincoln Twp Polk Co IA | Place of Birth |
| Father's Given Name | Wm |
Lightfoot | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Connecticut | 45 | Father's Age |
| Mother's Given Name | Nancy E. | Belden | Mother's Maiden Name |
| Mother's Surname | | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 38 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg IA | Medical Attendant's Address |