| Certificate Number | 149 | | Date Issued |
| Child Given Name | |
Hill | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Apr 1888 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | Frank W. |
Hill | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Iowa | 29 | Father's Age |
| Mother's Given Name | Delila | Lockwood | Mother's Maiden Name |
| Mother's Surname | Hill | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 29 | 2 | Number of Child This Mother |
| Medical Attendant's Name | P. Joor | Maxwell IA | Medical Attendant's Address |