| Certificate Number | 87 | | Date Issued |
| Child Given Name | Lucy Ellen |
Lee | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 Jan 1888 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Jacob |
Lee | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 32 | Father's Age |
| Mother's Given Name | Cordelia | Macy | Mother's Maiden Name |
| Mother's Surname | | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 28 | 6 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |