| Certificate Number | 89 | | Date Issued |
| Child Given Name | |
Baldus | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 19 Jan 1889 |
Lafayette Twp Story Co IA | Place of Birth |
| Father's Given Name | Theo. |
Baldus | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Germany | 52 | Father's Age |
| Mother's Given Name | Christina | Born | Mother's Maiden Name |
| Mother's Surname | | Lafayette Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 37 | 12 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |