| Certificate Number | 387 | | Date Issued |
| Child Given Name | Fawn M. |
Rowland | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 19 Sep 1886 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Thos. |
Rowland | Father's Surname |
| Father's Occupation | Butcher | | Father's Nationality |
| Father's Birth Place | Canada | | Father's Age |
| Mother's Given Name | Addie | McCluer | Mother's Maiden Name |
| Mother's Surname | Rowland | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | J.I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | J.I. Hostetter | | |