| Certificate Number | 183 | | Date Issued |
| Child Given Name | George Marcus |
Brumagin | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 16 Mar 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | M.K. |
Brumagin | Father's Surname |
| Father's Occupation | Clerk | | Father's Nationality |
| Father's Birth Place | New York | 26 | Father's Age |
| Mother's Given Name | Martha J. | Hanson | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |