| Certificate Number | 51 | | Date Issued |
| Child Given Name | Roy Harrison |
Picht | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 Dec 1888 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Picht | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Germany | 32 | Father's Age |
| Mother's Given Name | Clara M. | French | Mother's Maiden Name |
| Mother's Surname | | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 27 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Abbie P. Miller | Colo IA | Medical Attendant's Address |