| Certificate Number | 9 | | Date Issued |
| Child Given Name | Hazel L. |
Kiehlow | Child Surname |
| Child Sex | |
W | Child Race |
| Date of Birth | 11 Oct 1889 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | August |
Kiehlow | Father's Surname |
| Father's Occupation | Carpenter | | Father's Nationality |
| Father's Birth Place | Germany | 41 | Father's Age |
| Mother's Given Name | Lillian | Barnard | Mother's Maiden Name |
| Mother's Surname | | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 34 | | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |