| Certificate Number | 711 | | Date Issued |
| Child Given Name | Engene Hill |
Grafton | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Aug 1883 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | W.H. |
Grafton | Father's Surname |
| Father's Occupation | Physician | American | Father's Nationality |
| Father's Birth Place | Maryland | 56 | Father's Age |
| Mother's Given Name | Sarah Britany | Livingston | Mother's Maiden Name |
| Mother's Surname | Grafton | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 33 | 5 | Number of Child This Mother |
| Medical Attendant's Name | W.H. Grafton | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | W.H. Grafton | Cambridge IA | Certificate Signer's Address |
| Returned by Name | W.H. Grafton | | |