| Certificate Number | 154 | | Date Issued |
| Child Given Name | Ola Jane |
Brouhard | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Mar 1889 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | Barnard |
Brouhard | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 42 | Father's Age |
| Mother's Given Name | Martha | Laird | Mother's Maiden Name |
| Mother's Surname | | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 36 | 8 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |