| Certificate Number | 487 | | Date Issued |
| Child Given Name | |
Allen | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 16 Feb 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | William |
Allen | Father's Surname |
| Father's Occupation | Blacksmith | Scotland | Father's Nationality |
| Father's Birth Place | Scotland | 40 | Father's Age |
| Mother's Given Name | Mary | McCracken | Mother's Maiden Name |
| Mother's Surname | Allen | | Mother's Residence |
| Mother's Nationality | Scotch | Scotland | Mother's Birth Place |
| Mother's Age | 34 | 9 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |