| Certificate Number | 132 | | Date Issued |
| Child Given Name | John William |
Marford | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 07 Feb 1881 |
New Albay Twp Stor Co IA | Place of Birth |
| Father's Given Name | John Thos |
Marford | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 34 | Father's Age |
| Mother's Given Name | Amelia | Boyd | Mother's Maiden Name |
| Mother's Surname | Marford | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 34 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Jno I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | Jno I. Hostetter | | |