| Certificate Number | 341 | | Date Issued |
| Child Given Name | |
Hill | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Jun 1886 |
Onondago St. Ames Story Co IA | Place of Birth |
| Father's Given Name | Hector |
Hill | Father's Surname |
| Father's Occupation | Cooper | | Father's Nationality |
| Father's Birth Place | Norway | 27 | Father's Age |
| Mother's Given Name | Martha G. | Heggan | Mother's Maiden Name |
| Mother's Surname | Hill | Onondago St Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 21 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.L., Mrs. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J.L., Mrs. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | J.L., Mrs. Bartlett | | |