| Certificate Number | 232 | | Date Issued |
| Child Given Name | |
Cameron | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 09 Jul 1890 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Wm |
Carmeron | Father's Surname |
| Father's Occupation | Brick moulder | | Father's Nationality |
| Father's Birth Place | Indiana | 30 | Father's Age |
| Mother's Given Name | Lizzie | Stanley | Mother's Maiden Name |
| Mother's Surname | | Zenorville IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Dr. Beverly | Ames IA | Medical Attendant's Address |