| Certificate Number | 309 | | Date Issued |
| Child Given Name | |
Guthrie | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 May 1886 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | John W. |
Guthrie | Father's Surname |
| Father's Occupation | Carpenter | | Father's Nationality |
| Father's Birth Place | Highland Co OH | 39 | Father's Age |
| Mother's Given Name | Mary M. | Williams | Mother's Maiden Name |
| Mother's Surname | Guthrie | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | | Adams Co OH | Mother's Birth Place |
| Mother's Age | 36 | 7 | Number of Child This Mother |
| Medical Attendant's Name | S.E., Mrs. Burdick | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton | Zearing IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton | | |