| Certificate Number | 149 | | Date Issued |
| Child Given Name | Arthur Peter |
Ball | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 24 Jun 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Abdolonyous M. |
Ball | Father's Surname |
| Father's Occupation | Blacksmith | American | Father's Nationality |
| Father's Birth Place | Carrol Co IN | 37 | Father's Age |
| Mother's Given Name | Barbara Elizabeth | Hopkins | Mother's Maiden Name |
| Mother's Surname | Ball | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Jasper Co MO | Mother's Birth Place |
| Mother's Age | 37 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.L., Mrs. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J.L., Mrs. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | J.L., Mrs. Bartlett | | |