| Certificate Number | 582 | | Date Issued |
| Child Given Name | L.T. |
Fowler | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 18 May 1887 |
Elkart Twp Polk Co IA | Place of Birth |
| Father's Given Name | L.T. |
Fowler | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Mary | Hall | Mother's Maiden Name |
| Mother's Surname | Fowler | | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 29 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |