| Certificate Number | 385 | | Date Issued |
| Child Given Name | Willard |
Osborn | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 17 May 1882 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | W.A. |
Osborn | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Mother's Given Name | Bertha | McCracken | Mother's Maiden Name |
| Mother's Surname | Osborn | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Age | | 4 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merredith M.D. | | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merredith M.D. | | Certificate Signer's Address |
| Returned by Name | G.A. Merredith M.D. | | |