| Certificate Number | 1023 | | Date Issued |
| Child Given Name | |
Saunders | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 Sep 1884 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Frank F. |
Saunders | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Prince Edward Island | 33 | Father's Age |
| Mother's Given Name | Cora A. | Pond | Mother's Maiden Name |
| Mother's Surname | Saunders | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 22 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |