| Certificate Number | 462 | | Date Issued |
| Child Given Name | Edward Hoag |
Monk | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Dec 1886 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | E.H. |
Monk | Father's Surname |
| Father's Occupation | Doctor | | Father's Nationality |
| Father's Birth Place | Ohio | 37 | Father's Age |
| Mother's Given Name | Lillian | Hong | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Nevada Story Co IA | Mother's Birth Place |
| Mother's Age | 38 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |