| Certificate Number | 596 | | Date Issued |
| Child Given Name | Grace |
Brown | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 25 Aug 1887 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | J.M. |
Brown | Father's Surname |
| Father's Occupation | Physician | | Father's Nationality |
| Father's Birth Place | Indiana | 45 | Father's Age |
| Mother's Given Name | Sarah G. | Gillett | Mother's Maiden Name |
| Mother's Surname | Brown | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 31 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |