| Certificate Number | 182 | | Date Issued |
| Child Given Name | |
Robb | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Mar 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | J.F. |
Robb | Father's Surname |
| Father's Occupation | Clerk | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Minnie E. | Waters | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |