| Child Given Name | Albert Eugene |
Fowler | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 14 May 1890 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Frank Nickerson |
Fowler | Father's Surname |
| Father's Occupation | Manager Grain Co. | American | Father's Nationality |
| Father's Birth Place | Searsport ME | 32 | Father's Age |
| Mother's Given Name | Lottie | Trent | Mother's Maiden Name |
| Mother's Nationality | American | Maine | Mother's Birth Place |
| Mother's Age | 28 | 1 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Aplin, M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | C.A. Aplin, M.D. | Ames IA | Certificate Signer's Address |