| Certificate Number | 307 | | Date Issued |
| Child Given Name | |
Spratt | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 31 Dec 1881 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Wm. G. |
Spratt | Father's Surname |
| Father's Occupation | Clerk | American | Father's Nationality |
| Father's Birth Place | New York | 26 | Father's Age |
| Mother's Given Name | Rosa A. | Brouhard | Mother's Maiden Name |
| Mother's Surname | Spratt | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Frazee M.D. | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo. Frazee M.D. | Colo IA | Certificate Signer's Address |
| Returned by Name | Geo. Frazee M.D. | | |