| Certificate Number | 533 | | Date Issued |
| Child Given Name | |
Ufford | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 29 Dec 1882 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm. Alfred |
Ufford | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 30 | Father's Age |
| Mother's Given Name | Dulcina Jane | Clancy | Mother's Maiden Name |
| Mother's Surname | Ufford | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton M.D. | Zearing | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton M.D. | Zearing | Certificate Signer's Address |
| Returned by Name | F.S. Newton M.D. | | |