| Certificate Number | 139 | | Date Issued |
| Child Given Name | Harrison Alger |
Dick | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Mar 1890 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | Jonas |
Dick | Father's Surname |
| Father's Occupation | Mason | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 48 | Father's Age |
| Mother's Given Name | Martha | Spier | Mother's Maiden Name |
| Mother's Surname | | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 39 | 10 | Number of Child This Mother |
| Medical Attendant's Name | P. Joor | Maxwell Ia | Medical Attendant's Address |