| Certificate Number | 414 | | Date Issued |
| Child Given Name | Mildred Edna |
Haman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Oct 1886 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | G.W. |
Hayman | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 29 | Father's Age |
| Mother's Given Name | Flora A. | White | Mother's Maiden Name |
| Mother's Surname | Hayman | | Mother's Residence |
| Mother's Nationality | | Pennsylvania | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell | | |