| Certificate Number | 237 | | Date Issued |
| Child Given Name | |
Spencer | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Aug 1889 |
Lafayette Twp Story Co IA | Place of Birth |
| Father's Given Name | W.C. |
Spencer | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Illinois | 28 | Father's Age |
| Mother's Given Name | Hattie | Williamson | Mother's Maiden Name |
| Mother's Surname | | Lafayette Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 24 | 1 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |