| Certificate Number | 241 | | Date Issued |
| Child Given Name | Earnest |
Anderson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 13 Jul 1889 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Robert |
Anderson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 51 | Father's Age |
| Mother's Given Name | Annie | Massingham | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | West Virginia | Mother's Birth Place |
| Mother's Age | 40 | | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |