| Certificate Number | 576 | | Date Issued |
| Child Given Name | |
Hidy | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 May 1887 |
Collins Story Co IA | Place of Birth |
| Father's Given Name | W.C. |
Hidy | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Ohio | 31 | Father's Age |
| Mother's Given Name | Caroline | Hampton | Mother's Maiden Name |
| Mother's Surname | Hidy | | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 28 | 3 | Number of Child This Mother |
| Medical Attendant's Name | A.P. Edgar | Collins IA | Medical Attendant's Address |