| Certificate Number | 268 | | Date Issued |
| Child Given Name | Cephues |
Russ | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 30 Oct 1881 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Cephluss B. |
Russ | Father's Surname |
| Father's Occupation | Grain Dealer | American | Father's Nationality |
| Father's Birth Place | Connecticut | 34 | Father's Age |
| Mother's Given Name | Augusta | 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 | 29 | | Number of Child This Mother |
| Medical Attendant's Name | S.J. Starr | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | S.J. Starr | Ames IA | Certificate Signer's Address |
| Returned by Name | S.J. Starr | | |