| Certificate Number | 362 | | Date Issued |
| Child Given Name | Lillian Vida |
Lyman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 23 Sep 1889 |
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 | 28 | Father's Age |
| Mother's Given Name | Emily | Dipple | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Kansas | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |