| Certificate Number | 249 | | Date Issued |
| Child Given Name | |
Watke | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 Jan 1886 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Fred |
Watke | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Germany | 29 | Father's Age |
| Mother's Given Name | Annah Ellen | Schatz | Mother's Maiden Name |
| Mother's Surname | Watke | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Germany | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Jno Hostetter | Colo IA | Medical Attendant's Address |