| Certificate Number | 133 | | Date Issued |
| Child Given Name | Edward L. |
Baldus | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Mar 1888 |
Lafayette Twp Story Co IA | Place of Birth |
| Father's Given Name | Theo. W. |
Baldus | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 33 | Father's Age |
| Mother's Given Name | Amelia J. | Jacobs | Mother's Maiden Name |
| Mother's Surname | Baldus | Lafayette Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Connecticut | Mother's Birth Place |
| Mother's Age | 32 | 4 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |