| Certificate Number | 28 | | Date Issued |
| Child Given Name | Annie Laurie |
Bowen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Nov 1887 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | Jesse |
Bowen | Father's Surname |
| Father's Occupation | Hotel Keeper | | Father's Nationality |
| Father's Birth Place | Indiana | 48 | Father's Age |
| Mother's Given Name | Mary E. | Will | Mother's Maiden Name |
| Mother's Surname | Bowen | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Virginia | Mother's Birth Place |
| Mother's Age | 41 | 10 | Number of Child This Mother |
| Medical Attendant's Name | P. Joor | Maxwell Ia | Medical Attendant's Address |