| Certificate Number | 370 | | Date Issued |
| Child Given Name | |
Gilmore | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 07 Apr 1882 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm. |
Gilmore | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 32 | Father's Age |
| Mother's Given Name | Jerusha | Norton | Mother's Maiden Name |
| Mother's Surname | Gilmore | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 26 | 7 | Number of Child This Mother |
| Medical Attendant's Name | G.H. Meridith | | Medical Attendant's Address |
| Certificate Signer's Name | G.H. Meridith | | Certificate Signer's Address |
| Returned by Name | G.H. Meridith | | |