| Certificate Number | 548 | | Date Issued |
| Child Given Name | Clarence William |
Tewksbury | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Apr 1887 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo. |
Tewksbury | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 27 | Father's Age |
| Mother's Given Name | Joanna | McCartney | Mother's Maiden Name |
| Mother's Surname | Tewksbury | | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |