| Certificate Number | 229 | | Date Issued |
| Child Given Name | B.F.O. |
Funson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Nov 1889 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | H.M. |
Funson | Father's Surname |
| Father's Occupation | Attorney | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 37 | Father's Age |
| Mother's Given Name | Ella | Shugart | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 29 | 2 | Number of Child This Mother |
| Medical Attendant's Name | George Stitzell | Nevada IA | Medical Attendant's Address |