| Certificate Number | 205 | | Date Issued |
| Child Given Name | |
Arrasmith | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 24 Aug 1890 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | John M. |
Arrasmith | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Story Co IA | 30 | Father's Age |
| Mother's Given Name | Annie B. | Wrutch | Mother's Maiden Name |
| Mother's Surname | | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Germany | Mother's Birth Place |
| Mother's Age | 32 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Albert Richmond | Ames IA | Medical Attendant's Address |