| Certificate Number | 46 | | Date Issued |
| Child Given Name | Edward |
Bates | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 01 Dec 1888 |
Walnut Grove | Place of Birth |
| Father's Given Name | C. |
Bates | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Michigan | 25 | Father's Age |
| Mother's Given Name | Sophia M. | Olson | Mother's Maiden Name |
| Mother's Surname | Bates | Walnut Grove | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |