| Certificate Number | 524 | | Date Issued |
| Child Given Name | Isabel Talette |
Mason | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 24 Nov 1882 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Morris M. |
Mason | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 27 | Father's Age |
| Mother's Given Name | Chrisina | Heggen | Mother's Maiden Name |
| Mother's Surname | Mason | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hays M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hays M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hays M.D. | | |