| Certificate Number | 76 | | Date Issued |
| Child Given Name | Manuel Earl |
Dakin | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 Oct 1884 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | S.W. |
Dakin | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Canada | 37 | Father's Age |
| Mother's Given Name | C.E. | Grosley | Mother's Maiden Name |
| Mother's Surname | Dakin | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Lincoln Twp Story Co IA | Mother's Birth Place |
| Mother's Age | | 1 | Number of Child This Mother |
| Medical Attendant's Name | Fannie McClain | McCallsburg IA | Medical Attendant's Address |
| Certificate Signer's Name | Fannie McClain | MaCallsburg IA | Certificate Signer's Address |
| Returned by Name | P. McClain | | |