| Certificate Number | 247 | | Date Issued |
| Child Given Name | |
Boyd | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Aug 1889 |
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 | Greencastle IA | 28 | Father's Age |
| Mother's Given Name | Virginia | Boyd | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Tennessee | Mother's Birth Place |
| Mother's Age | 22 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Colson | Nevada IA | Medical Attendant's Address |