| Certificate Number | 584 | | Date Issued |
| Child Given Name | Oliver Guy |
Cook | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 07 Jul 1887 |
Collins Story Co IA | Place of Birth |
| Father's Given Name | Franklin C. |
Cool | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Frances E. | Davis | Mother's Maiden Name |
| Mother's Surname | Cool | Collins Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.P. Edgar | Collins IA | Medical Attendant's Address |
| Certificate Signer's Name | A.P. Edgar | Collins IA | Certificate Signer's Address |
| Returned by Name | A.P. Edgar | | |