| Certificate Number | 8 | | Date Issued |
| Child Given Name | |
Reynolds | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Oct 1891 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Arthur W. |
Reynolds | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Story Co IA | 32 | Father's Age |
| Mother's Given Name | Matilda W. | Cameron | Mother's Maiden Name |
| Mother's Surname | Reynolds | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 34 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |