| Certificate Number | 67 | | Date Issued |
| Child Given Name | Lyman B? |
Gilbert | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 28 Oct 1880 |
Gilbert Station Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Franklin Barr |
Gilbert | Father's Surname |
| Father's Occupation | Merchant | American | Father's Nationality |
| Father's Birth Place | Wisconson | 28 | Father's Age |
| Mother's Given Name | May Arabella | Cook | Mother's Maiden Name |
| Mother's Surname | Gilbert | Gilbert Station Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 21 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Rachel Marshall | Gilbert Station IA | Medical Attendant's Address |
| Certificate Signer's Name | Rachel Marshall | Gilbert Station IA | Certificate Signer's Address |
| Returned by Name | Rachel Marshall | | |