| Certificate Number | 163 | | Date Issued |
| Child Given Name | |
Oliver | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 09 Jun 1890 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | C.A. |
Oliver | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Missouri | 29 | Father's Age |
| Mother's Given Name | Theo | Bissell | Mother's Maiden Name |
| Mother's Surname | | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Minnesota | Mother's Birth Place |
| Mother's Age | 23 | | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |