| Certificate Number | 127 | | Date Issued |
| Child Given Name | |
Morrison | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 23 Feb 1881 |
Collins Twp Story Co IA | Place of Birth |
| Father's Given Name | John A. |
Morrison | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 47 | Father's Age |
| Mother's Given Name | Fannie J. | Wilson | Mother's Maiden Name |
| Mother's Surname | Morrison | Collins Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 41 | 12 | 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 | | |