| Certificate Number | 506 | | Date Issued |
| Child Given Name | John Leonard |
Abbott | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Mar 1887 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | William |
Abbott | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 43 | Father's Age |
| Mother's Given Name | Mary | Ballard | Mother's Maiden Name |
| Mother's Surname | Abbott | | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 30 | 3 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | A.S. Aplin | Cambridge IA | Certificate Signer's Address |
| Returned by Name | A.S. Aplin | | |