| Certificate Number | 271 | | Date Issued |
| Child Given Name | Geo. G. |
Maxwell | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 16 Aug 1889 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Sidney I. |
Maxwell | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Story Co IA | 28 | Father's Age |
| Mother's Given Name | May | Hall | Mother's Maiden Name |
| Mother's Surname | | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 27 | 3 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |