| Certificate Number | 137 | | Date Issued |
| Child Given Name | |
Turner | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 14 Jun 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | N.A. |
Turner | Father's Surname |
| Father's Occupation | Machinest | American | Father's Nationality |
| Father's Birth Place | Wisconson | 29 | Father's Age |
| Mother's Given Name | Anna | Miller | Mother's Maiden Name |
| Mother's Surname | Turner | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | Dane | Denmark | Mother's Birth Place |
| Mother's Age | 29 | 1 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merideth | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merideth | | |