| Certificate Number | 98 | | Date Issued |
| Child Given Name | |
McVey | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 28 Dec 1880 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Silas J. |
McVey | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 23 | Father's Age |
| Mother's Given Name | Martha F. | Holstclaw | Mother's Maiden Name |
| Mother's Surname | McVey | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 21 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Geo Frazee | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Frazee | Colo IA | Certificate Signer's Address |
| Returned by Name | Geo Frazee | | |