| Certificate Number | 615 | | Date Issued |
| Child Given Name | |
Hadley | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Aug 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Seth |
Hadley | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Vermont | 69 | Father's Age |
| Mother's Given Name | Sarah | Chandler | Mother's Maiden Name |
| Mother's Surname | Hadley | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Massachusets | Mother's Birth Place |
| Mother's Age | 20 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |