| Certificate Number | 202 | | Date Issued |
| Child Given Name | |
Trowbridge | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 Sep 1890 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Albert I. |
Trowbridge | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 21 | Father's Age |
| Mother's Given Name | Addie M. | Morgan | Mother's Maiden Name |
| Mother's Surname | | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Albert Richmond | Ames IA | Medical Attendant's Address |