| Certificate Number | 22 | | Date Issued |
| Child Given Name | David H. |
Gilchrist | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Oct 1889 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Jas. R. |
Gilchrist | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 29 | Father's Age |
| Mother's Given Name | Lillie J. | Hutchinson | Mother's Maiden Name |
| Mother's Surname | | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Pennsylvania | Mother's Birth Place |
| Mother's Age | | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |