| Certificate Number | 238 | | Date Issued |
| Child Given Name | |
Patten | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 23 Sep 1881 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Randolph |
Patten | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 28 | Father's Age |
| Mother's Given Name | Frances A. | Williams | Mother's Maiden Name |
| Mother's Surname | Patten | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Vermont | Mother's Birth Place |
| Mother's Age | 27 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Lewis Schooler | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Lewis Schooler | Nevada IA | Certificate Signer's Address |
| Returned by Name | Lewis Schooler | | |