| Certificate Number | 587 | | Date Issued |
| Child Given Name | |
Watson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 28 Jun 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | F.M. |
Watson | Father's Surname |
| Father's Occupation | Railroader | | Father's Nationality |
| Father's Birth Place | Kansas | 30 | Father's Age |
| Mother's Given Name | Susan L. | Osborn | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 32 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J.L., Mrs. Bartlett | Ames IA | Medical Attendant's Address |