| Certificate Number | 10 | | Date Issued |
| Child Given Name | Lew W. |
McElyea | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Sep 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | C.W. |
McElyea | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 30 | Father's Age |
| Mother's Given Name | Sadie F. | Fitchpatrick | Mother's Maiden Name |
| Mother's Surname | McElyea | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 32 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |