| Certificate Number | 205 | | Date Issued |
| Child Given Name | Lucy Emma |
Baldwin | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 07 Jul 1881 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Zackrine Murry |
Baldwin | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 32 | Father's Age |
| Mother's Given Name | Savalla Eddy | Brown | Mother's Maiden Name |
| Mother's Surname | Baldwin | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Scotch | Rockford IL | Mother's Birth Place |
| Mother's Age | 28 | 3 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Lincoln Twp | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton | Lincon Twp | Certificate Signer's Address |
| Returned by Name | F.S. Newton | | |