| Certificate Number | 67 | | Date Issued |
| Child Given Name | |
Springman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Jan 1888 |
Lafayette Twp Story Co IA | Place of Birth |
| Father's Given Name | H.M. |
Springman | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 31 | Father's Age |
| Mother's Given Name | S. Ada | Jackson | Mother's Maiden Name |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 29 | 2 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |