| Certificate Number | 132 | | Date Issued |
| Child Given Name | |
Brown | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Mar 1889 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Daniel H. |
Brown | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Adams Co PA | 35 | Father's Age |
| Mother's Given Name | Mary E. | Wiergert | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Franklin Co PA | Mother's Birth Place |
| Mother's Age | 32 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |