| Certificate Number | 551 | | Date Issued |
| Child Given Name | Charlie Edward |
Newpost | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 Apr 1887 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Thos. L. |
Newport | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Indiana | 24 | Father's Age |
| Mother's Given Name | L.E. | Meek | Mother's Maiden Name |
| Mother's Surname | Newport | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Zearing IA | Medical Attendant's Address |