| Certificate Number | 322 | | Date Issued |
| Child Given Name | |
Templeton | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 28 Jan 1882 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm. Osker |
Templeton | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 39 | Father's Age |
| Mother's Given Name | Ann E. | Ginter | Mother's Maiden Name |
| Mother's Surname | Templeton | Story Co IA | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 32 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J. Daughtery | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J. Daughtery | Ames IA | Certificate Signer's Address |
| Returned by Name | J. Daughtery | | |