| Certificate Number | 28 | | Date Issued |
| Child Given Name | Henry |
Egland | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Thos |
Egland | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Story Co IA | 30 | Father's Age |
| Mother's Given Name | Martha | Red | Mother's Maiden Name |
| Mother's Surname | | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 27 | 4 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |