| Certificate Number | 713 | | Date Issued |
| Child Given Name | Grace Luella |
Sawyer | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Aug 1883 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Frank |
Sawyer | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Louisa C. | Briley | Mother's Maiden Name |
| Mother's Surname | Sawyer | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 24 | 4 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |