| Certificate Number | 302 | | Date Issued |
| Child Given Name | James G. |
Harper | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 17 Sep 1889 |
Iowa Center Story Co IA | Place of Birth |
| Father's Given Name | Isaiah |
Harper | Father's Surname |
| Father's Occupation | Shoemaker | | Father's Nationality |
| Father's Birth Place | Ohio | 59 | Father's Age |
| Mother's Given Name | Amanda | Tabor | Mother's Maiden Name |
| Mother's Surname | | Iowa Center Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 33 | 6 | Number of Child This Mother |
| Medical Attendant's Name | Frank Thompson | | Medical Attendant's Address |