| Certificate Number | 348 | | Date Issued |
| Child Given Name | |
Moses | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 27 Mar 1882 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Jacob |
Moses | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 31 | Father's Age |
| Mother's Given Name | Alice May | Briggs | Mother's Maiden Name |
| Mother's Surname | Moses | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 25 | 4 | Number of Child This Mother |
| Medical Attendant's Name | G.H. Merrideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.H. Merrideth | Ames IA | Certificate Signer's Address |
| Returned by Name | 'By mail' | | |