| Certificate Number | 605 | | Date Issued |
| Child Given Name | John Devine |
Lounsberry | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 Jul 1887 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | John H. |
Lounsberry | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 32 | Father's Age |
| Mother's Given Name | Roxie | Danskin | Mother's Maiden Name |
| Mother's Surname | | Sherman Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Canada | Mother's Birth Place |
| Mother's Age | 29 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |