| Certificate Number | 35 | | Date Issued |
| Child Given Name | |
Hoel | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 16 Nov 1888 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Hoel | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 29 | Father's Age |
| Mother's Given Name | Emma | Jackson | Mother's Maiden Name |
| Mother's Surname | Hoel | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffrey | Nevada IA | Medical Attendant's Address |