| Certificate Number | 411 | | Date Issued |
| Child Given Name | Quincy Rosee |
Wright | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Aug 1882 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Chas. H. |
Wright | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 22 | Father's Age |
| Mother's Given Name | Mary Elizabeth | Guthrie | Mother's Maiden Name |
| Mother's Surname | Wright | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 23 | 3 | Number of Child This Mother |
| Certificate Signer's Name | Susannah C. Jerren | | Certificate Signer's Address |
| Returned by Name | Susannah C. Jerren | | |