| Certificate Number | 834 | | Date Issued |
| Child Given Name | Elizabeth |
Cook | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 15 Dec 1883 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Chas |
Cook | Father's Surname |
| Father's Occupation | Saddler | American | Father's Nationality |
| Father's Birth Place | New York | 45 | Father's Age |
| Mother's Given Name | Henriette | Watson | Mother's Maiden Name |
| Mother's Surname | Cook | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | North Carolina | Mother's Birth Place |
| Mother's Age | 48 | 15 | Number of Child This Mother |