| Certificate Number | 206 | | Date Issued |
| Child Given Name | Hugh R. |
Allen | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 31 Jul 1885 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | O.D. |
Allen | Father's Surname |
| Father's Occupation | Farmer | U.S. | Father's Nationality |
| Father's Birth Place | Pennsylvania | | Father's Age |
| Mother's Given Name | Sarah | Strukland | Mother's Maiden Name |
| Mother's Surname | Allen | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | U.S. | New York | Mother's Birth Place |
| Mother's Age | | 6 | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | D.S. Fairchild | Ames IA | Certificate Signer's Address |
| Returned by Name | D.S. Fairchild | | |