| Certificate Number | 431 | | Date Issued |
| Child Given Name | |
Olinger | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 17 Sep 1886 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | James M. |
Olinger | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 43 | Father's Age |
| Mother's Given Name | Rebecca J. | Johnson | Mother's Maiden Name |
| Mother's Surname | Olinger | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 42 | 10 | Number of Child This Mother |
| Medical Attendant's Name | P. Joor | Maxwell IA | Medical Attendant's Address |
| Certificate Signer's Name | P. Joor | Maxwell IA | Certificate Signer's Address |
| Returned by Name | P. Joor | | |