| Certificate Number | 263 | | Date Issued |
| Child Given Name | Cephas |
Russ | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 22 Oct 1881 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Cephas Brigham |
Russ | Father's Surname |
| Father's Occupation | Grain Buyer | American | Father's Nationality |
| Father's Birth Place | Connecticut | 34 | Father's Age |
| Mother's Given Name | Augusta Clarissa | Dexter | Mother's Maiden Name |
| Mother's Surname | Russ | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | | 5 | Number of Child This Mother |
| Medical Attendant's Name | I.J. Starr | | Medical Attendant's Address |
| Certificate Signer's Name | Jane L., Mrs. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | Jane L., Mrs. Bartlett | | |