| Certificate Number | 798 | | Date Issued |
| Child Given Name | |
Corbin | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 24 Oct 1883 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Corbin | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 35 | Father's Age |
| Mother's Given Name | Mary E. | Hubbard | Mother's Maiden Name |
| Mother's Surname | Corbin | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 32 | 6 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | J.I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | J.I. Hostetter | | |