| Certificate Number | 205 | | Date Issued |
| Child Given Name | Hoyt Wood |
Pizer | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 16 Jul 1888 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | Edward W. |
Pizer | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | England | 27 | Father's Age |
| Mother's Given Name | Carrie E. | Wood | Mother's Maiden Name |
| Mother's Surname | | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Frank Thompson | Iowa Center IA | Medical Attendant's Address |