| Certificate Number | 558 | | Date Issued |
| Child Given Name | |
Curren | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Chas. |
Curren | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Massachusets | 27 | Father's Age |
| Mother's Given Name | Mary | McDonald | Mother's Maiden Name |
| Mother's Surname | Curren | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 27 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Catherine McDonald | Richland Twp IA | Medical Attendant's Address |
| Returned by Name | Chas. Curren | | |