| Certificate Number | 260 | | Date Issued |
| Child Given Name | |
Beadle | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Feb 1886 |
Ontario Story Co IA | Place of Birth |
| Father's Given Name | Wm |
Beadle | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Alice | Baughman | Mother's Maiden Name |
| Mother's Surname | Beadle | Ontario Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A. Beverly | Ames IA | Medical Attendant's Address |