| Certificate Number | 208 | | Date Issued |
| Child Given Name | |
Paxton | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 18 Jul 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Wm. A. |
Paxton | Father's Surname |
| Father's Occupation | Salesman | | Father's Nationality |
| Father's Birth Place | Illinois | 36 | Father's Age |
| Mother's Given Name | Rachel | Winter | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |