| Certificate Number | 564 | | Date Issued |
| Child Given Name | |
Saunders | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 May 1887 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Mike A. |
Saunders | Father's Surname |
| Father's Occupation | Black Smith | | Father's Nationality |
| Father's Birth Place | Canada | 27 | Father's Age |
| Mother's Given Name | Lina | Hoskins | Mother's Maiden Name |
| Mother's Surname | Saunders | | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |