| Certificate Number | 206 | | Date Issued |
| Child Given Name | Arle Eugene |
McDonald | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 04 Jul 1881 |
Grant Twp Hardin Co IA | Place of Birth |
| Father's Given Name | William Henry |
McDonald | Father's Surname |
| Father's Occupation | Farmer | Canadian | Father's Nationality |
| Father's Birth Place | Upper Canada | 37 | Father's Age |
| Mother's Given Name | Mary Elizabeth | Pendall | Mother's Maiden Name |
| Mother's Surname | McDonald | Grant Twp Hardin Co IA | Mother's Residence |
| Mother's Nationality | American | Rockford IL | Mother's Birth Place |
| Mother's Age | 27 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Hissard, Dr. Hubbard | Hardin Co IA | Medical Attendant's Address |
| Certificate Signer's Name | Hissard, Dr. Hubbard | Hardin Co IA | Certificate Signer's Address |
| Returned by Name | Hissard, Dr. Hubbard | | |