| Certificate Number | 514 | | Date Issued |
| Child Given Name | Philip Bogardus |
Ream | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 Mar 1887 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Philip H. |
Ream | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Mother's Given Name | L.L. | Cripps | Mother's Maiden Name |
| Mother's Surname | | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 33 | 8 | Number of Child This Mother |
| Medical Attendant's Name | L.A., Mrs. Cassidy | Union Twp IA | Medical Attendant's Address |
| Returned by Name | L.A., Mrs. Cassidy | | |