| Certificate Number | 33 | | Date Issued |
| Child Given Name | |
Thomas | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Oct 1888 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Franklin P. |
Thomas | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 36 | Father's Age |
| Mother's Given Name | | Hill | Mother's Maiden Name |
| Mother's Surname | | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 27 | 5 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |