| Certificate Number | 244 | | Date Issued |
| Child Given Name | |
Henryson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 01 Jan 1886 |
Hamilton Co IA | Place of Birth |
| Father's Given Name | Thomas |
Henryson | Father's Surname |
| Father's Occupation | Agent | | Father's Nationality |
| Father's Birth Place | | 31 | Father's Age |
| Mother's Given Name | H.S. | Hoover | Mother's Maiden Name |
| Mother's Surname | Henryson | Hamilton Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 24 | 1 | Number of Child This Mother |
| Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |