| Certificate Number | 203 | | Date Issued |
| Child Given Name | Lydia B. |
Brown | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Aug 1890 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | K.W. |
Brown | Father's Surname |
| Father's Occupation | Com. Traveller | | Father's Nationality |
| Father's Birth Place | New York | 46 | Father's Age |
| Mother's Given Name | Maggie B. | Mitchell | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 30 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Albert Richmond | Ames IA | Medical Attendant's Address |