| Certificate Number | 238 | | Date Issued |
| Child Given Name | Ralph Stuart |
Anderson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 13 Jan 1886 |
| Place of Birth |
| Father's Given Name | Robt. S. |
Anderson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 50 | Father's Age |
| Mother's Given Name | Annie | Massingham | Mother's Maiden Name |
| Mother's Surname | Anderson | | Mother's Residence |
| Mother's Nationality | | Virginia | Mother's Birth Place |
| Mother's Age | 37 | 7 | Number of Child This Mother |
| Medical Attendant's Name | A.W. Brooks | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | A.W. Brooks | Zearing IA | Certificate Signer's Address |
| Returned by Name | A.W. Brooks | | |