| Certificate Number | 355 | | Date Issued |
| Child Given Name | Frank |
McNeish | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 07 Feb 1882 |
| Place of Birth |
| Father's Given Name | John |
McNeish | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 55 | Father's Age |
| Mother's Given Name | Henretta | Hurst | Mother's Maiden Name |
| Mother's Surname | McNeish | Kelley Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 34 | 8 | Number of Child This Mother |
| Medical Attendant's Name | P.H. Sharp M.D. | Kelley IA | Medical Attendant's Address |
| Certificate Signer's Name | P.H. Sharp M.D. | Kelley IA | Certificate Signer's Address |
| Returned by Name | P.H. Sharp M.D. | | |