| Certificate Number | 308 | | Date Issued |
| Child Given Name | |
Wright | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 May 1886 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | Charles W. |
Wright | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Adams Co OH | 26 | Father's Age |
| Mother's Given Name | Mary E. | Guthrie | Mother's Maiden Name |
| Mother's Surname | Wright | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Adams Co OH | Mother's Birth Place |
| Mother's Age | 26 | 5 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton M.D. | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton M.D. | Zearing IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton M.D. | | |