| Certificate Number | 740 | | Date Issued |
| Child Given Name | Laura Grace |
McCain | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 09 Aug 1883 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | J.H. |
McCain | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 53 | Father's Age |
| Mother's Given Name | Phoebe C. | Wheatley | Mother's Maiden Name |
| Mother's Surname | McCain | Sherman Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 35 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Mead | Sherman Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Mrs. Mead | Sherman Twp IA | Certificate Signer's Address |
| Returned by Name | Mrs. Mead | | |