| Certificate Number | 141 | | Date Issued |
| Child Given Name | Kenneth |
Hollingsworth | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 May 1890 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | A. |
Hollingsworth | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Marshall Co IA | 28 | Father's Age |
| Mother's Given Name | Jennie | Way | Mother's Maiden Name |
| Mother's Surname | | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Marshall Co IA | Mother's Birth Place |
| Mother's Age | | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg IA | Medical Attendant's Address |