| Certificate Number | 139 | | Date Issued |
| Child Given Name | Gid |
Morgan | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 11 Feb 1881 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | William S. |
Morgan | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | New York | 41 | Father's Age |
| Mother's Given Name | Mary | Fox | Mother's Maiden Name |
| Mother's Surname | Morgan | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 40 | 7 | 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 | 'Mail' | | |