| Certificate Number | 588 | | Date Issued |
| Child Given Name | |
Thayer | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 18 Jul 1887 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | W.H. |
Thayer | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Michigan | 27 | Father's Age |
| Mother's Given Name | Margaret | Conrad | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Green Co IA | Mother's Birth Place |
| Mother's Age | 26 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffrey | Nevada IA | Medical Attendant's Address |