| Certificate Number | 478 | | Date Issued |
| Child Given Name | John |
McDowell | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 04 Aug 1882 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Robert |
McDowell | Father's Surname |
| Father's Occupation | Temperance Billiard Hall | American | Father's Nationality |
| Father's Birth Place | Ohio | 35 | Father's Age |
| Mother's Given Name | Matilda | Petry | Mother's Maiden Name |
| Mother's Surname | McDowell | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 29 | 2 | Number of Child This Mother |
| Medical Attendant's Name | James Bradley M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | James Bradley M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | James Bradley M.D. | | |