| Certificate Number | 885 | | Date Issued |
| Child Given Name | |
Harrison | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Feb 1884 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | H.J. |
Harrison | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Wisconson | 39 | Father's Age |
| Mother's Given Name | Mary Jane | Graves | Mother's Maiden Name |
| Mother's Surname | Harrison | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Wisconson | Mother's Birth Place |
| Mother's Age | 33 | 8 | Number of Child This Mother |
| Medical Attendant's Name | H.J. Harrison | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | H.J. Harrison | Cambridge IA | Certificate Signer's Address |
| Returned by Name | H.J. Harrison | | |