| Certificate Number | 298 | | Date Issued |
| Child Given Name | Austin |
Larson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 23 Dec 1881 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Charles |
Larson | Father's Surname |
| Father's Occupation | Merchant | American | Father's Nationality |
| Father's Birth Place | Illinois | 28 | Father's Age |
| Mother's Given Name | Bell | Anderson | Mother's Maiden Name |
| Mother's Surname | Larson | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Illinois | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hayes M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes M.D. | | |