| Certificate Number | 288 | | Date Issued |
| Child Given Name | |
Wier | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 05 Sep 1889 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | M.E. |
Wier | Father's Surname |
| Father's Occupation | Operator | | Father's Nationality |
| Father's Birth Place | Story City IA | 21 | Father's Age |
| Mother's Given Name | Minnie E. | Reid | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Nevada Story Co IA | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |