| Certificate Number | 522 | | Date Issued |
| Child Given Name | J. Lester |
Hardesty | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 29 Mar 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | David |
Hardesty | Father's Surname |
| Father's Birth Place | Ohio | 30 | Father's Age |
| Mother's Given Name | Nettie A. | Bronson | Mother's Maiden Name |
| Mother's Surname | Hardesty | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 27 | 4 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |