| Certificate Number | 259 | | Date Issued |
| Child Given Name | |
Mangus | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Sep 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | James E. |
Mangus | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 29 | Father's Age |
| Mother's Given Name | Rachel | Munden | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 21 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A. Richmond | Ames IA | Medical Attendant's Address |