| Certificate Number | 180 | | Date Issued |
| Child Given Name | |
Silliman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 May 1889 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Homer N. |
Silliman | Father's Surname |
| Father's Occupation | Banker | | Father's Nationality |
| Father's Birth Place | Whiteside Co IL | 23 | Father's Age |
| Mother's Given Name | Nathalie | Hammond | Mother's Maiden Name |
| Mother's Surname | | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Hamilton Co IA | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |