| Certificate Number | 33 | | Date Issued |
| Child Given Name | |
Brown | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 28 Nov 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Morgan B. |
Brown | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Illinois | 27 | Father's Age |
| Mother's Given Name | Ellen A. | Chase | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 23 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Jane L. Bartlett | Ames IA | Medical Attendant's Address |