| Certificate Number | 480 | | Date Issued |
| Child Given Name | Ernest Lyle |
Hiestand | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 31 Jan 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Saml E. |
Hiestand | Father's Surname |
| Father's Occupation | Restaurant Keeper | | Father's Nationality |
| Father's Birth Place | Iowa | 31 | Father's Age |
| Mother's Given Name | Daisy | Quackinbush | Mother's Maiden Name |
| Mother's Surname | Hiestand | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |