| Certificate Number | 274 | | Date Issued |
| Child Given Name | Chas. M. |
Gunder | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 06 Nov 1881 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Geo. B. |
Gunder | Father's Surname |
| Father's Occupation | Butter Maker & Laborer | American | Father's Nationality |
| Father's Birth Place | Illinois | 24 | Father's Age |
| Mother's Given Name | Sevila | Frogood | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | S.J. Starr | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | S.J. Starr | Ames IA | Certificate Signer's Address |
| Returned by Name | 'Mail' | | |