| Certificate Number | 231 | | Date Issued |
| Child Given Name | Robt. A. |
Ricketts | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Sep 1888 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | W.A. |
Ricketts | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 20 | Father's Age |
| Mother's Given Name | Lillie | Smith | Mother's Maiden Name |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |