| Certificate Number | 251 | | Date Issued |
| Child Given Name | |
Raff | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Sep 1880 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Enos |
Raff | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Carrie | Palmatier | Mother's Maiden Name |
| Mother's Surname | Raff | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | D.F. Fairchild | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | D.F. Fairchild | Ames IA | Certificate Signer's Address |
| Returned by Name | D.F. Fairchild | | |