| Certificate Number | 33 | | Date Issued |
| Child Given Name | Jennie Elizabeth |
Hoag | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Nov 1887 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | John C. |
Hoag | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 25 | Father's Age |
| Mother's Given Name | Ada M. | Brithwaite | Mother's Maiden Name |
| Mother's Surname | Hoag | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |