| Certificate Number | 280 | | Date Issued |
| Child Given Name | Homer Guy |
Runyon | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 11 Dec 1881 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | G.H. |
Runyon | Father's Surname |
| Father's Occupation | Butter & Egg Dealer | American | Father's Nationality |
| Father's Birth Place | Kentucky | 28 | Father's Age |
| Mother's Given Name | Sarah M. | Orvis | Mother's Maiden Name |
| Mother's Surname | Runyon | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merideth | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merideth | | |