| Certificate Number | 539 | | Date Issued |
| Child Given Name | |
Sheldon | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Feb 1887 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | Geo. E. |
Sheldon | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Illinois | 31 | Father's Age |
| Mother's Given Name | Arttisa | Butler | Mother's Maiden Name |
| Mother's Surname | Sheldon | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | | 3 | Number of Child This Mother |
| Medical Attendant's Name | P. Joor | Maxwell IA | Medical Attendant's Address |