| Certificate Number | 72 | | Date Issued |
| Child Given Name | |
Engman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Jan 1888 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Olaf B. |
Engman | Father's Surname |
| Father's Occupation | Clerk | | Father's Nationality |
| Father's Birth Place | Norway | 26 | Father's Age |
| Mother's Given Name | Mary | Rinertson | Mother's Maiden Name |
| Mother's Surname | Engman | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |