| Certificate Number | 1052 | | Date Issued |
| Child Given Name | Arthur |
Pryor | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Sep 1884 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Pryor | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 40 | Father's Age |
| Mother's Given Name | Francis | Shugart | Mother's Maiden Name |
| Mother's Surname | Pryor | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |