| Certificate Number | 259 | | Date Issued |
| Child Given Name | Arthur Raymond |
Northup | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 Oct 1881 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Jacob |
Northup | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Indiana | 26 | Father's Age |
| Mother's Given Name | Angeline | Love | Mother's Maiden Name |
| Mother's Surname | Northup | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Monk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Monk | | |