| Certificate Number | 75 | | Date Issued |
| Child Given Name | Isaac Howith |
Carl | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 14 Feb 1885 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | George |
Carl | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 48 | Father's Age |
| Mother's Given Name | Sarah | Green | Mother's Maiden Name |
| Mother's Surname | Carl | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 35 | 7 | Number of Child This Mother |
| Medical Attendant's Name | Fannie McClain | Warren Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Fannie McClain | Warren Twp IA | Certificate Signer's Address |
| Returned by Name | Fannie McClain | | |