| Certificate Number | 88 | | Date Issued |
| Child Given Name | |
Spratt | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 16 Mar 1885 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Wm. G. |
Spratt | Father's Surname |
| Father's Occupation | Grocerier | American | Father's Nationality |
| Father's Birth Place | New York | 29 | 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 | 23 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Jno I. Hostetter | | Medical Attendant's Address |
| Certificate Signer's Name | Jno I. Hostetter | | Certificate Signer's Address |
| Returned by Name | Jno I. Hostetter | | |