| Certificate Number | 227 | | Date Issued |
| Child Given Name | |
Patton | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 07 Jul 1889 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | Wm. |
Patton | Father's Surname |
| Father's Occupation | Clerk | | Father's Nationality |
| Father's Birth Place | Iowa | 30 | Father's Age |
| Mother's Given Name | | Barnes | Mother's Maiden Name |
| Mother's Surname | | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |