| Certificate Number | 1026 | | Date Issued |
| Child Given Name | |
McNaughton | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Aug 1884 |
| Place of Birth |
| Father's Given Name | Geo |
McNaughton | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Surname | | Zenorville Story Co IA | Mother's Residence |
| Mother's Nationality | American | Zenorville Story Co IA | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | C.A. Beverly | Ames IA | Certificate Signer's Address |
| Returned by Name | C.A. Beverly | | |