| Certificate Number | 1047 | | Date Issued |
| Child Given Name | William |
Leonard | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 07 Sep 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | C.R. |
Leonard | Father's Surname |
| Father's Occupation | Barber | American | Father's Nationality |
| Father's Birth Place | Utah | 31 | Father's Age |
| Mother's Given Name | Nellie | Hart | Mother's Maiden Name |
| Mother's Surname | Leonard | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | Irish | | Mother's Birth Place |
| Mother's Age | 23 | 5 | Number of Child This Mother |
| Medical Attendant's Name | G. Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | G. Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | G. Stitzell | | |