| Certificate Number | 292 | | Date Issued |
| Child Given Name | Lloyd Edgar |
Sargent | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Aug 1889 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Chauncey |
Sargent | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Michigan | 33 | Father's Age |
| Mother's Given Name | Beulah | Cowgill | Mother's Maiden Name |
| Mother's Surname | | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 27 | 5 | Number of Child This Mother |
| Medical Attendant's Name | E.C. Scott | Maxwell IA | Medical Attendant's Address |