| Certificate Number | 16 | | Date Issued |
| Child Given Name | |
Finch | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Oct 1884 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Marcus N. |
Finch | Father's Surname |
| Father's Occupation | Railroading | | Father's Nationality |
| Father's Birth Place | Wisconson | 34 | Father's Age |
| Mother's Given Name | Percinia A. | Bowman | Mother's Maiden Name |
| Mother's Surname | Finch | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Missouri | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |