| Certificate Number | 518 | | Date Issued |
| Child Given Name | Claude V. |
Campbell | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 13 Dec 1882 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Justus |
Campbell | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 24 | Father's Age |
| Mother's Given Name | Campbell | Hall | Mother's Maiden Name |
| Mother's Surname | Ada | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell M.D. | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell M.D. | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell M.D. | | |