| Certificate Number | 565 | | Date Issued |
| Child Given Name | |
Legland | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 17 May 1887 |
Ellwell Story Co IA | Place of Birth |
| Father's Given Name | Michael O. |
Legland | Father's Surname |
| Father's Occupation | Blacksmith | | Father's Nationality |
| Father's Birth Place | Iowa | 21 | Father's Age |
| Mother's Given Name | Corena T. | Twombly | Mother's Maiden Name |
| Mother's Surname | Legland | Ellwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 17 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |