| Certificate Number | 257 | | Date Issued |
| Child Given Name | William Edward |
Foils | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Feb 1885 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Edward Wm |
Foils | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 28 | Father's Age |
| Mother's Given Name | Mary | Burger | Mother's Maiden Name |
| Mother's Surname | Foils | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | F.T. Newton | Zearing IA | Medical Attendant's Address |