| Certificate Number | 354 | | Date Issued |
| Child Given Name | Clyde |
Oxley | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Sep 1889 |
Collins Twp Story Co IA | Place of Birth |
| Father's Given Name | John C. |
Oxley | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 23 | Father's Age |
| Mother's Given Name | Clara W. | Carr | Mother's Maiden Name |
| Mother's Surname | | Collins Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.P. Edgar | Collins IA | Medical Attendant's Address |