| Certificate Number | 58 | | Date Issued |
| Child Given Name | Henry Martin |
Spohn | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Dec 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | M.J. |
Spohn | Father's Surname |
| Father's Occupation | Mason | | Father's Nationality |
| Father's Birth Place | Ohio | 39 | Father's Age |
| Mother's Given Name | Viana Arbelle | Moore | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 31 | 7 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |