| Certificate Number | 513 | | Date Issued |
| Child Given Name | Orville Justus |
Harrison | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 31 Mar 1887 |
| Place of Birth |
| Father's Given Name | William C. |
Harrison | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Nevada Story Co IA | 24 | Father's Age |
| Mother's Given Name | Jennie May | Dame | Mother's Maiden Name |
| Mother's Surname | Harrison | | Mother's Residence |
| Mother's Nationality | | Iowa Center Story Co IA | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffrey | Nevada IA | Medical Attendant's Address |