| Certificate Number | 182 | | Date Issued |
| Child Given Name | Alma Althea |
Wire | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Aug 1885 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Gid J. |
Wire | Father's Surname |
| Father's Occupation | Carpenter | | Father's Nationality |
| Father's Birth Place | Ohio | 48 | Father's Age |
| Mother's Given Name | Alma A. | Southwick | Mother's Maiden Name |
| Mother's Surname | Wire | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 38 | 8 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |