| Certificate Number | 295 | | Date Issued |
| Child Given Name | |
McQuiston | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 22 Sep 1889 |
Collins Twp Story Co IA | Place of Birth |
| Father's Given Name | Chas. |
McQuiston | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Rose | Homes | Mother's Maiden Name |
| Mother's Surname | | Collins Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 25 | 3 | Number of Child This Mother |
| Medical Attendant's Name | N.W. Knepper | Collins IA | Medical Attendant's Address |