| Certificate Number | 292 | | Date Issued |
| Child Given Name | |
Viess | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 12 Jan 1882 |
New Philadelphia Story Co IA | Place of Birth |
| Father's Given Name | M.B. |
Viess | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 38 | Father's Age |
| Mother's Given Name | Annie | Cromet | Mother's Maiden Name |
| Mother's Surname | Viess | Boonsboro Boone Co IA | Mother's Residence |
| Mother's Nationality | Canadian | Canada | Mother's Birth Place |
| Mother's Age | 33 | 7 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Meridith M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Meridith M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Meridith M.D. | | |