| Certificate Number | 30 | | Date Issued |
| Child Given Name | |
Robb | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Nov 1888 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | James |
Robb | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 38 | Father's Age |
| Mother's Given Name | Anna M. | Wilson | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Pennsylvania | Mother's Birth Place |
| Mother's Age | 35 | 4 | Number of Child This Mother |
| Medical Attendant's Name | A. Richmond | Ames IA | Medical Attendant's Address |