| Certificate Number | 303 | | Date Issued |
| Child Given Name | John Hull |
Hostetter | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Apr 1886 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Jno I. |
Hostetter | Father's Surname |
| Father's Occupation | Physician | | Father's Nationality |
| Father's Birth Place | Illinois | 29 | Father's Age |
| Mother's Given Name | Lillie C. | Hull | Mother's Maiden Name |
| Mother's Surname | Hostetter | Colo Story 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 | Jno I. Hostetter | Colo IA | Medical Attendant's Address |