| Certificate Number | 457 | | Date Issued |
| Child Given Name | Dudly |
Pollock | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Dec 1886 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | James A. |
Pollock | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | | 30 | Father's Age |
| Mother's Given Name | | Hix | Mother's Maiden Name |
| Mother's Surname | Pollock | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Benton Co MO | Mother's Birth Place |
| Mother's Age | 22 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |