| Certificate Number | 700 | | Date Issued |
| Child Given Name | Oscar Lewis |
Ryerson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 13 Jun 1883 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Lewis |
Ryerson | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 42 | Father's Age |
| Mother's Given Name | Elizabeth | Brown | Mother's Maiden Name |
| Mother's Surname | Ryerson | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 37 | | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown M.D. | | |