| Certificate Number | 356 | | Date Issued |
| Child Given Name | |
Renne | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Jul 1886 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | James Wm. |
Renne | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ogle Co IL | 25 | Father's Age |
| Mother's Given Name | Alice L. | Wiley | Mother's Maiden Name |
| Mother's Surname | Renne | Ogle Co IL | Mother's Residence |
| Mother's Nationality | | Ogle Co IL | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | H.D. Chamberlain | Nevada IA | Certificate Signer's Address |
| Returned by Name | H.D. Chamberlain | | |