| Certificate Number | 41 | | Date Issued |
| Child Given Name | |
Granger | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Dec 1887 |
Collins Story Co IA | Place of Birth |
| Father's Given Name | S.G. |
Granger | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 34 | Father's Age |
| Mother's Given Name | Charlotte | Snook | Mother's Maiden Name |
| Mother's Surname | Granger | Collins Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 34 | 4 | Number of Child This Mother |
| Medical Attendant's Name | A.P. Edgar | Collins IA | Medical Attendant's Address |