| Certificate Number | 7 | | Date Issued |
| Child Given Name | |
Dunklebarger | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Oct 1891 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | O. |
Dunklebarger | Father's Surname |
| Father's Occupation | Farmer & Stock Dealer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 39 | Father's Age |
| Mother's Given Name | Nettie | Briggs | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Nevada Story Co IA | Mother's Birth Place |
| Mother's Age | 31 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |