| Certificate Number | 22 | | Date Issued |
| Child Given Name | |
Kibbee | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 07 Nov 1887 |
Gilbert Story Co IA | Place of Birth |
| Father's Given Name | Alonza B. |
Kibbee | Father's Surname |
| Father's Occupation | Stock Dealer | | Father's Nationality |
| Father's Birth Place | Iowa | 39 | Father's Age |
| Mother's Given Name | Sarah J. | Ferguson | Mother's Maiden Name |
| Mother's Surname | | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 32 | 2 | Number of Child This Mother |
| Medical Attendant's Name | R. Marshall | Gilbert IA | Medical Attendant's Address |