| Certificate Number | 599 | | Date Issued |
| Child Given Name | |
Sibbit | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Jul 1887 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | James W. |
Sibbit | Father's Surname |
| Father's Occupation | Preacher | | Father's Nationality |
| Father's Birth Place | Washington Co PA | 32 | Father's Age |
| Mother's Given Name | Anna M. | Dibble | Mother's Maiden Name |
| Mother's Surname | Sibbits | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 49 | 2 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |