| Certificate Number | 427 | | Date Issued |
| Child Given Name | Etty |
Warren | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 09 Jul 1882 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Jefferson C. |
Warren | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 31 | Father's Age |
| Mother's Given Name | Mary R. | Huff | Mother's Maiden Name |
| Mother's Surname | Warren | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Medical Attendant's Name | N. Robinson M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | N. Robinson M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | N. Robinson M.D. | | |