| Certificate Number | 85 | | Date Issued |
| Child Given Name | Geo A. |
Bolton | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 01 Jan 1888 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Frank L. |
Bolton | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Cora | Hutchins | Mother's Maiden Name |
| Mother's Surname | Bolton | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.W. Bro | Zearing IA | Medical Attendant's Address |