| Certificate Number | 432 | | Date Issued |
| Child Given Name | Ettie S. |
Maxwell | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Apr 1882 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Geo. M. |
Maxwell | Father's Surname |
| Father's Occupation | Merchant | American | Father's Nationality |
| Father's Birth Place | Ohio | 68 | Father's Age |
| Mother's Given Name | Angeline | Sweet | Mother's Maiden Name |
| Mother's Surname | Maxwell | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 40 | 9 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hays M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hays M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hays M.D. | | |