| Certificate Number | 191 | | Date Issued |
| Child Given Name | Denver W. |
Hoot | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 May 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Howard S. |
Hoot | Father's Surname |
| Father's Occupation | Photographer | | Father's Nationality |
| Father's Birth Place | Williams Co OH | 31 | Father's Age |
| Mother's Given Name | May Pearl | Read | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Columbia Co WI | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Jane L. Bartlett | Ames IA | Medical Attendant's Address |