| Certificate Number | 31 | | Date Issued |
| Child Given Name | Lois |
Boardman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 18 Apr 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Wm K. |
Boardman | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Vermont | 34 | Father's Age |
| Mother's Given Name | Addie H. | Hemingsen | Mother's Maiden Name |
| Mother's Surname | Boardman | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 29 | 2 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |