| Certificate Number | 183 | | Date Issued |
| Child Given Name | |
Keef | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 16 Aug 1885 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Daniel |
Keef | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Hamilton Co IA | 28 | Father's Age |
| Mother's Given Name | Viola W. | Webb | Mother's Maiden Name |
| Mother's Surname | Keef | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |
| Certificate Signer's Name | C.W. Allen | Story City IA | Certificate Signer's Address |
| Returned by Name | C.W. Allen | | |