| Certificate Number | 34 | | Date Issued |
| Child Given Name | |
Oliver | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 Nov 1887 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | C.A. |
Oliver | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Wisconson | 26 | Father's Age |
| Mother's Given Name | Theo | Bissell | Mother's Maiden Name |
| Mother's Surname | Oliver | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Minnesota | Mother's Birth Place |
| Mother's Age | 25 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Richmond | Ames IA | Medical Attendant's Address |