| Certificate Number | 118 | | Date Issued |
| Child Given Name | Henry Barnes |
Marshall | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Apr 1885 |
Gilbert Station Story Co IA | Place of Birth |
| Father's Given Name | William |
Marshall | Father's Surname |
| Father's Occupation | Station Agent Operator | American | Father's Nationality |
| Father's Birth Place | Illinois | 29 | Father's Age |
| Mother's Given Name | Mary I. | Barnes | Mother's Maiden Name |
| Mother's Surname | Marshall | Gilbert Station Story Co IA | Mother's Residence |
| Mother's Nationality | American | Wisconson | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Rachael Marshall | Franklin Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Rachael Marshall | Franklin Twp IA | Certificate Signer's Address |
| Returned by Name | Rachael Marshall | | |