| Certificate Number | 249 | | Date Issued |
| Child Given Name | Isaac E.B. |
Pratt | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 15 Aug 1890 |
Collins Story Co IA | Place of Birth |
| Father's Given Name | Geo. E. |
Pratt | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Wisconson | 30 | Father's Age |
| Mother's Given Name | Cora | Bricker | Mother's Maiden Name |
| Mother's Surname | | Collins Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 28 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A.P. Edgar | Collins IA | Medical Attendant's Address |