| Certificate Number | 18 | | Date Issued |
| Child Given Name | Grace Gertie |
Mathews | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Jul 1880 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | William |
Mathews | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Wisconson | 30 | Father's Age |
| Mother's Given Name | Sarah Elizabeth | Halliday | Mother's Maiden Name |
| Mother's Surname | Mathews | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Jonesville WI | Mother's Birth Place |
| Mother's Age | 24 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Rachel Marshall | Gilbert Station IA | Medical Attendant's Address |