| Certificate Number | 373 | | Date Issued |
| Child Given Name | Leslie J. |
Saunders | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 13 Aug 1886 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | F.F. |
Saunders | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | British Dominion | | Father's Age |
| Mother's Given Name | Cora Adela | Pond | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 23 | 4 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |