| Certificate Number | 74 | | Date Issued |
| Child Given Name | Jas. F. |
Beatty | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 05 Jan 1889 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Jas. E. |
Beatty | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Goshen IN | 26 | Father's Age |
| Mother's Given Name | Dora | Hull | Mother's Maiden Name |
| Mother's Surname | | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Des Moines IA | Mother's Birth Place |
| Mother's Age | 26 | 2 | Number of Child This Mother |
| Medical Attendant's Name | F. Thompson | Iowa Center IA | Medical Attendant's Address |