| Certificate Number | 101 | | Date Issued |
| Child Given Name | Laura E. |
Brown | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Mar 1888 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | J.W. |
Brown | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | New York | 29 | Father's Age |
| Mother's Given Name | Margaret | Took | Mother's Maiden Name |
| Mother's Surname | Brown | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 22 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |