| Certificate Number | 235 | | Date Issued |
| Child Given Name | Thomas Montgomery |
McCall | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Dec 1887 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | John M. |
McCall | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 30 | Father's Age |
| Mother's Given Name | Olive | Quick | Mother's Maiden Name |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 22 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |