| Certificate Number | 450 | | Date Issued |
| Child Given Name | Lloyd E. |
Ginter | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 04 Dec 1886 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm L. |
Ginter | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 31 | Father's Age |
| Mother's Given Name | Laura | Vail | Mother's Maiden Name |
| Mother's Surname | Ginter | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 29 | 6 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | 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 | | |