| Certificate Number | 389 | | Date Issued |
| Child Given Name | Margaret |
See | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 02 Mar 1882 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Frank |
See | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | | Father's Age |
| Mother's Given Name | Amanda | Corben | Mother's Maiden Name |
| Mother's Surname | See | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | | 4 | Number of Child This Mother |
| Medical Attendant's Name | A.W. Squires M.D. | | Medical Attendant's Address |
| Certificate Signer's Name | A.W. Squires M.D. | | Certificate Signer's Address |
| Returned by Name | A.W. Squires M.D. | | |