| Certificate Number | 236 | | Date Issued |
| Child Given Name | |
Baldus | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 01 Sep 1889 |
Lafayette Twp Story Co IA | Place of Birth |
| Father's Given Name | George |
Baldus | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Story Co IA | 30 | Father's Age |
| Mother's Given Name | Jennie | Mangus | 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 | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |