| Certificate Number | 502 | | Date Issued |
| Child Given Name | Roy H. |
Spratt | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 05 Mar 1887 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | W.G. |
Spratt | Father's Surname |
| Father's Occupation | Clerk | | Father's Nationality |
| Father's Birth Place | New York | 31 | Father's Age |
| Mother's Given Name | Rosa A. | Brouhard | Mother's Maiden Name |
| Mother's Surname | Spratt | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 25 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |