| Certificate Number | 491 | | Date Issued |
| Child Given Name | R.D. |
Snelling | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 Jan 1887 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | F.B. |
Snelling | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 41 | Father's Age |
| Mother's Given Name | I. | Mead | Mother's Maiden Name |
| Mother's Surname | Snelling | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Canada | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |