| Certificate Number | 205 | | Date Issued |
| Child Given Name | Cicil Dean |
Warren | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 15 Jun 1889 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | J.E. |
Warren | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 24 | Father's Age |
| Mother's Given Name | Alice M. | Wharton | Mother's Maiden Name |
| Mother's Surname | | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |