| Child Given Name | Clifford Sylvester |
Bates | Child Surname |
| Child Sex | W |
W | Child Race |
| Date of Birth | 11 Jan 1887 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Sylvester Freeman |
Bates | Father's Surname |
| Father's Occupation | Butcher | | Father's Nationality |
| Father's Birth Place | Michigan | 30 | Father's Age |
| Mother's Given Name | Betty Jane | Harrison | Mother's Maiden Name |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 26 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Arthur, Dr. Aplin | | Medical Attendant's Address |
| Certificate Signer's Name | Myrtle May Yeoman | Ames IA | Certificate Signer's Address |