| Certificate Number | 48 | | Date Issued |
| Child Given Name | Adah |
Livingston | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 27 Dec 1884 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Francis Marion |
Livingston | Father's Surname |
| Father's Occupation | Merchant | American | Father's Nationality |
| Father's Birth Place | Iowa | 31 | Father's Age |
| Mother's Given Name | Bessie | Ringheim | Mother's Maiden Name |
| Mother's Surname | Livingston | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 31 | 1 | Number of Child This Mother |
| Medical Attendant's Name | W.H. Grafton | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | W.H. Grafton | Cambridge IA | Certificate Signer's Address |
| Returned by Name | W.H. Grafton | | |