| Certificate Number | 901 | | Date Issued |
| Child Given Name | Andrew Phillip |
Yonker | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Jan 1884 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Isaac Henry |
Yonker | Father's Surname |
| Father's Occupation | Farmer | Canadian | Father's Nationality |
| Father's Birth Place | Canada | 34 | Father's Age |
| Mother's Given Name | Hortense | Cooley | Mother's Maiden Name |
| Mother's Surname | Yonker | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 29 | 6 | Number of Child This Mother |
| Medical Attendant's Name | J.L., Mrs. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J.L., Mrs. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | J.L., Mrs. Bartlett | | |