| Certificate Number | 341 | | Date Issued |
| Child Given Name | |
Sparks | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 14 Jan 1889 |
Zenorsville Story Co IA | Place of Birth |
| Father's Given Name | John |
Sparks | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | New York | 34 | Father's Age |
| Mother's Surname | | Zenorville Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 32 | 5 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |