| Certificate Number | 150 | | Date Issued |
| Child Given Name | O.O. |
Abraham | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 22 Feb 1890 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Oscar |
Abraham | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 30 | Father's Age |
| Mother's Given Name | Eliza A. | Osborn | Mother's Maiden Name |
| Mother's Surname | | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |