| Certificate Number | 250 | | Date Issued |
| Child Given Name | |
Beck | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Aug 1889 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | D.W.C. |
Beck | Father's Surname |
| Father's Occupation | Veterinary Surgeon | | Father's Nationality |
| Father's Birth Place | New York | 49 | Father's Age |
| Mother's Given Name | Barbara | Malloys | Mother's Maiden Name |
| Mother's Surname | | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Scotland | Mother's Birth Place |
| Mother's Age | 34 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |