| Certificate Number | 8 | | Date Issued |
| Child Given Name | Harry |
Cox | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 14 Sep 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | A.J. |
Cox | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Ohio | 40 | Father's Age |
| Mother's Given Name | Lily | Ricketts | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 32 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Jam L. Bartlett | Ames IA | Medical Attendant's Address |