| Certificate Number | 98 | | Date Issued |
| Child Given Name | |
Watson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Mar 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Francis M. |
Watson | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Kansas | 28 | Father's Age |
| Mother's Given Name | Susan Lilly | Osborn | Mother's Maiden Name |
| Mother's Surname | Watson | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 30 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Cunningham | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J.L., Mrs. Bartlett | | Certificate Signer's Address |
| Returned by Name | J.L., Mrs. Bartlett | | |