| Certificate Number | 45 | | Date Issued |
| Child Given Name | |
Slingerland | Child Surname |
| Child Sex | Male |
A | Child Race |
| Date of Birth | 25 Sep 1880 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Wesley |
Slingerland | Father's Surname |
| Father's Occupation | Furniture Merchant | American | Father's Nationality |
| Father's Birth Place | New York | 32 | Father's Age |
| Mother's Given Name | Mary | Cunningham | Mother's Maiden Name |
| Mother's Surname | Slingerland | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 28 | 3 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Meridith | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Meridith | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Meridith | | |