| Certificate Number | 172 | | Date Issued |
| Child Given Name | Wm Clyde |
Keef | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 Jun 1888 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Timothy |
Keef | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 33 | Father's Age |
| Mother's Given Name | Alice | Seal | Mother's Maiden Name |
| Mother's Surname | | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 29 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Frank Thompson | Iowa Center IA | Medical Attendant's Address |