| Certificate Number | 196 | | Date Issued |
| Child Given Name | Emil |
Krug | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 24 Sep 1885 |
Boone Co IA | Place of Birth |
| Father's Given Name | Henry |
Krug | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Germany | 34 | Father's Age |
| Mother's Given Name | Anna | Martins | Mother's Maiden Name |
| Mother's Surname | Krug | Boone Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 30 | 3 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | C.A. Beverly | Ames IA | Certificate Signer's Address |
| Returned by Name | C.A. Beverly | | |