| Certificate Number | 79 | | Date Issued |
| Child Given Name | James G. |
Robinson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Jan 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Horace |
Robinson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | New York | 35 | Father's Age |
| Mother's Given Name | Elsie C. | Barr | Mother's Maiden Name |
| Mother's Surname | Robinson | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 29 | 5 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | E.B. Plumb M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | E.B. Plumb M.D. | | |