| Certificate Number | 604 | | Date Issued |
| Child Given Name | Mary |
Hankins | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 19 Jul 1887 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Davis |
Hankins | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 35 | Father's Age |
| Mother's Given Name | Mary | Wood | Mother's Maiden Name |
| Mother's Surname | | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 30 | | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |