| Certificate Number | 327 | | Date Issued |
| Child Given Name | Lee R. |
Boyd | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Jun 1886 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | John H. |
Boyd | Father's Surname |
| Father's Occupation | Butcher | | Father's Nationality |
| Father's Birth Place | Jasper Co IA | 25 | Father's Age |
| Mother's Given Name | Virginia | Boyd | Mother's Maiden Name |
| Mother's Surname | Boyd | Emporia Kansas | Mother's Residence |
| Mother's Nationality | | Tennessee | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | H.D. Chamberlain | Nevada IA | Certificate Signer's Address |
| Returned by Name | H.D. Chamberlain | | |