| Certificate Number | 179 | | Date Issued |
| Child Given Name | Orlie Ross |
Thompson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Mar 1888 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Isaac Ross |
Thompson | Father's Surname |
| Father's Occupation | Railroader | Irish | Father's Nationality |
| Father's Birth Place | Michigan | 35 | Father's Age |
| Mother's Given Name | Luella Florence | Ramsey | Mother's Maiden Name |
| Mother's Nationality | Irish | Indiana | Mother's Birth Place |
| Mother's Age | 25 | | Number of Child This Mother |
| Medical Attendant's Name | A.S., Dr. Aplin | Cambridge IA | Medical Attendant's Address |