| Certificate Number | 30 | | Date Issued |
| Child Given Name | Howard |
Johnson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 28 Oct 1889 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Henry |
Johnson | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Norway | 33 | Father's Age |
| Mother's Given Name | Ruth | Wire | Mother's Maiden Name |
| Mother's Surname | | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |