| Certificate Number | 541 | | Date Issued |
| Child Given Name | |
Lyman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 May 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | T.J. |
Lyman | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Alabama | 25 | Father's Age |
| Mother's Given Name | Emily | Dipple | Mother's Maiden Name |
| Mother's Surname | Lyman | | Mother's Residence |
| Mother's Nationality | | Kansas | Mother's Birth Place |
| Mother's Age | 18 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |