| Certificate Number | 423 | | Date Issued |
| Child Given Name | Maud |
Rowland | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 18 Jul 1882 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Thomas |
Rowland | Father's Surname |
| Father's Occupation | Farmer | Canadian | Father's Nationality |
| Father's Birth Place | Canada | 34 | Father's Age |
| Mother's Given Name | Adeline | McClure | Mother's Maiden Name |
| Mother's Surname | Rowland | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 29 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Jno I. Hostetter M.D. | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno I. Hostetter M.D. | Colo IA | Certificate Signer's Address |
| Returned by Name | Jno I. Hostetter M.D. | | |