| Certificate Number | 95 | | Date Issued |
| Child Given Name | |
Cole | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 28 Dec 1887 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm |
Cole | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 30 | Father's Age |
| Mother's Given Name | Louisa | Perkins | Mother's Maiden Name |
| Mother's Surname | Cole | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 29 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | | Medical Attendant's Address |