| Certificate Number | 93 | | Date Issued |
| Child Given Name | Reuben Milton |
McClelland | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 12 Dec 1880 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Samuel Armon |
McClelland | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 23 | Father's Age |
| Mother's Given Name | Melsena | Springer | Mother's Maiden Name |
| Mother's Surname | McClelland | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell | | |