| Certificate Number | 860 | | Date Issued |
| Child Given Name | Arthur Leonard |
Holmes | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 07 Jan 1884 |
Collins Twp Story Co IA | Place of Birth |
| Father's Given Name | Thomas |
Holmes | Father's Surname |
| Father's Occupation | Farmer | English | Father's Nationality |
| Father's Birth Place | England | 26 | Father's Age |
| Mother's Given Name | Dora Mai | McQuish | Mother's Maiden Name |
| Mother's Surname | Holmes | Collins Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | N.W. Knepper | Collins IA | Medical Attendant's Address |
| Certificate Signer's Name | N.W. Knepper | Collins IA | Certificate Signer's Address |
| Returned by Name | N.W. Knepper | | |