| Certificate Number | 107 | | Date Issued |
| Child Given Name | Loid |
Sowers | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 15 Jan 1889 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | T.J. |
Sowers | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 38 | Father's Age |
| Mother's Given Name | Mary M. | Smith | Mother's Maiden Name |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 36 | 8 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |