| Certificate Number | 722 | | Date Issued |
| Child Given Name | John A. |
Boston | Child Surname |
| Child Sex | Male |
M | Child Race |
| Date of Birth | 31 May 1883 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | William Alford |
Boston | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 29 | Father's Age |
| Mother's Given Name | Haldah Jane | Springer | Mother's Maiden Name |
| Mother's Surname | Boston | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 30 | 3 | Number of Child This Mother |
| Medical Attendant's Name | S.B., Mrs. Boston | McCallsburg IA | Medical Attendant's Address |
| Certificate Signer's Name | S.B., Mrs. Boston | McCallsburg IA | Certificate Signer's Address |
| Returned by Name | S.B., Mrs. Boston | | |