| Certificate Number | 618 | | Date Issued |
| Child Given Name | |
Pryor | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Sep 1887 |
| Place of Birth |
| Father's Given Name | John |
Pryor | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | | 44 | Father's Age |
| Mother's Given Name | | Pryor | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 4 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |