| Certificate Number | 63 | | Date Issued |
| Child Given Name | William L. |
Osborn | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Dec 1889 |
McCallsburg Story Co IA | Place of Birth |
| Father's Given Name | J.W. |
Osborn | Father's Surname |
| Father's Occupation | Physician | | Father's Nationality |
| Father's Birth Place | Butler Co OH | 26 | Father's Age |
| Mother's Given Name | Anna | Kriegh | Mother's Maiden Name |
| Mother's Surname | | McCallsburg Story Co IA | Mother's Residence |
| Mother's Nationality | | Davis Co IA | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg IA | Medical Attendant's Address |