| Certificate Number | 120 | | Date Issued |
| Child Given Name | Chas. W. |
Yeager | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Apr 1888 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Henry |
Yeager | Father's Surname |
| Father's Occupation | Station Agt | | Father's Nationality |
| Father's Birth Place | Switzerland | 29 | Father's Age |
| Mother's Given Name | Anna | Weber | Mother's Maiden Name |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 24 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |