| Certificate Number | 448 | | Date Issued |
| Child Given Name | |
Hamelan | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 28 Nov 1886 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Henry C. |
Hamelan | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Germany | 29 | Father's Age |
| Mother's Given Name | Hannah | Colman | Mother's Maiden Name |
| Mother's Surname | Hamelan | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton | Zearing IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton | | |