| Certificate Number | 73 | | Date Issued |
| Child Given Name | |
Brunson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 01 Feb 1885 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Emory H. |
Brunson | Father's Surname |
| Father's Occupation | Barber | | Father's Nationality |
| Father's Birth Place | Illinois | 30 | Father's Age |
| Mother's Given Name | Catherine E. | Ellis | Mother's Maiden Name |
| Mother's Surname | Brunson | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Michigan | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |