| Certificate Number | 340 | | Date Issued |
| Child Given Name | Clarence |
Airhart | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 04 Jul 1886 |
| Place of Birth |
| Father's Given Name | Fred |
Airhart | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Nobel Co IL | 23 | Father's Age |
| Mother's Given Name | Pamelia F. | Finch | Mother's Maiden Name |
| Mother's Surname | Airhart | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Boone Co IA | Mother's Birth Place |
| Mother's Age | 17 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | H.D. Chambelain | Nevada IA | Certificate Signer's Address |
| Returned by Name | H.D. Chamberlain | | |