| Certificate Number | 153 | | Date Issued |
| Child Given Name | |
Hilton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Jun 1885 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Thomas |
Hilton | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 28 | Father's Age |
| Mother's Given Name | Sarah | Oxley | Mother's Maiden Name |
| Mother's Surname | Hilton | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 24 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Vandewalker | Peoria City IA | Medical Attendant's Address |
| Certificate Signer's Name | J.W. Vandewalker | Peoria City IA | Certificate Signer's Address |
| Returned by Name | J.W. Vandewalker | | |