| Certificate Number | 215 | | Date Issued |
| Child Given Name | Harry Moses |
Manges | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 Aug 1888 |
Story Co IA | Place of Birth |
| Father's Given Name | Charles E. |
Manges | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 25 | Father's Age |
| Mother's Given Name | Clara M. | Moses | Mother's Maiden Name |
| Mother's Surname | | Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |