| Certificate Number | 265 | | Date Issued |
| Child Given Name | George Edward |
Brown | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 18 Dec 1885 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | J.W. |
Brown | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | New York | | Father's Age |
| Mother's Given Name | Maggie | Zook | Mother's Maiden Name |
| Mother's Surname | Brown | | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Smith M.D. | Nevada IA | Medical Attendant's Address |