| Certificate Number | 47 | | Date Issued |
| Child Given Name | August Jr. |
Nolly | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Dec 1889 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | August |
Nolly | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 28 | Father's Age |
| Mother's Given Name | Vena | Wolert | Mother's Maiden Name |
| Mother's Nationality | | Scott Co IA | Mother's Birth Place |
| Mother's Age | 22 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Theo Engle | State Center IA | Medical Attendant's Address |