| Certificate Number | 179 | | Date Issued |
| Child Given Name | Maud |
Saunders | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Oct 1885 |
| Place of Birth |
| Father's Given Name | Mike A. |
Saunders | Father's Surname |
| Father's Occupation | Blacksmith | | Father's Nationality |
| Father's Birth Place | Canada | 27 | Father's Age |
| Mother's Given Name | Linnie | Hoskins | Mother's Maiden Name |
| Mother's Surname | Saunders | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 18 | 1 | 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 | | |