| Certificate Number | 118 | | Date Issued |
| Child Given Name | Almon |
Seal | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 Apr 1890 |
| Place of Birth |
| Father's Given Name | Joseph A. |
Seal | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Story Co IA | 24 | Father's Age |
| Mother's Given Name | Minnie B. | Batterson | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 17 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffry | Nevada IA | Medical Attendant's Address |