| Certificate Number | 58 | | Date Issued |
| Child Given Name | Albert K. |
Grafton | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 Sep 1880 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | William C. |
Grafton | Father's Surname |
| Father's Occupation | Physician | American | Father's Nationality |
| Father's Birth Place | Baltimore MD | 53 | Father's Age |
| Mother's Given Name | Sarah A. | Livingston | Mother's Maiden Name |
| Mother's Surname | Grafton | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Belmont Co OH | Mother's Birth Place |
| Mother's Age | 30 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Wm H. Grafton | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | Wm H. Grafton | Cambridge IA | Certificate Signer's Address |
| Returned by Name | 'Mail' | | |