| Certificate Number | 94 | | Date Issued |
| Child Given Name | |
Shaw | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 Jan 1888 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | James A. |
Shaw | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | New York | 39 | Father's Age |
| Mother's Given Name | Alice | Reynolds | Mother's Maiden Name |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 34 | 4 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |