| Certificate Number | 93 | | Date Issued |
| Child Given Name | Charles Loren |
Fleck | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Feb 1890 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | John W. |
Fleck | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Mahaska Co IA | 36 | Father's Age |
| Mother's Given Name | Rachel | Hilton | Mother's Maiden Name |
| Mother's Surname | | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 32 | 7 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg IA | Medical Attendant's Address |