| Certificate Number | 122 | | Date Issued |
| Child Given Name | Claud L. |
Sanders | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Apr 1890 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Eden W. |
Sanders | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 24 | Father's Age |
| Mother's Given Name | Eva B. | Spencer | Mother's Maiden Name |
| Mother's Surname | | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg | Medical Attendant's Address |