| Certificate Number | 80 | | Date Issued |
| Child Given Name | Ray J. |
Plumb | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 23 Jan 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Edward B. |
Plumb | Father's Surname |
| Father's Occupation | Physician | | Father's Nationality |
| Father's Birth Place | Illinois | 25 | Father's Age |
| Mother's Given Name | Grace Gertrude | Maule | Mother's Maiden Name |
| Mother's Surname | Plumb | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | E.B. Plumb M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | E.B. Plumb M.D. | | |