| Certificate Number | 44 | | Date Issued |
| Child Given Name | |
Heers | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Nov 1886 |
Lafayette Twp Story Co IA | Place of Birth |
| Father's Given Name | H.E. |
Heers | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Des Moines Polk Co IA | 24 | Father's Age |
| Mother's Given Name | Mary | Albertson | Mother's Maiden Name |
| Mother's Surname | | Lafayette Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Des Moines Polk Co IA | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |