| Certificate Number | 266 | | Date Issued |
| Child Given Name | |
Dunlap | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Oct 1881 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | James |
Dunlap | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 45 | Father's Age |
| Mother's Given Name | Charlotte F. | Wallera | Mother's Maiden Name |
| Mother's Surname | Dunlap | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 45 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Peter Joor | Iowa Center IA | Medical Attendant's Address |
| Certificate Signer's Name | Peter Joor | Iowa Center IA | Certificate Signer's Address |
| Returned by Name | Peter Joor | | |