| Certificate Number | 169 | | Date Issued |
| Child Given Name | Murindle |
Richardson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 17 Aug 1885 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | Edward G. |
Richardson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 36 | Father's Age |
| Mother's Given Name | Sarah B. | Burton | Mother's Maiden Name |
| Mother's Surname | Richardson | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 37 | 7 | Number of Child This Mother |
| Medical Attendant's Name | Toby, Mrs. Severson | Union Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Toby, Mrs. Severson | Union Twp IA | Certificate Signer's Address |
| Returned by Name | Lewis Rierson | | |