| Certificate Number | 138 | | Date Issued |
| Child Given Name | Ira Alfred |
Silliman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Jun 1885 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | R.J. |
Silliman | Father's Surname |
| Father's Occupation | Banker | American | Father's Nationality |
| Father's Birth Place | Illinois | 43 | Father's Age |
| Mother's Given Name | Lucy | Newman | Mother's Maiden Name |
| Mother's Surname | Silliman | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 42 | 6 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |