| Certificate Number | 156 | | Date Issued |
| Child Given Name | William Thomas |
Kielly | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Mar 1889 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Kielly | Father's Surname |
| Father's Occupation | Farmer | Irish | Father's Nationality |
| Father's Birth Place | Ireland | 48 | Father's Age |
| Mother's Given Name | Margaret | Smith | Mother's Maiden Name |
| Mother's Surname | Kielly | Story Co IA | Mother's Residence |
| Mother's Nationality | | Ireland | Mother's Birth Place |
| Mother's Age | 47 | 6 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |