| Certificate Number | 144 | | Date Issued |
| Child Given Name | Henry |
Bauer | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 May 1888 |
| Place of Birth |
| Father's Given Name | Christian |
Bauer | Father's Surname |
| Father's Occupation | Shoe Maker | | Father's Nationality |
| Father's Birth Place | Germany | 26 | Father's Age |
| Mother's Given Name | Annie | Chicks | Mother's Maiden Name |
| Mother's Surname | Bauer | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Germany | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |