| Certificate Number | 780 | | Date Issued |
| Child Given Name | |
Dunahoo | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 13 Jun 1883 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | M. |
Dunahoo | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | | 26 | Father's Age |
| Mother's Given Name | Jennie | Selby | Mother's Maiden Name |
| Mother's Surname | Dunahoo | Nevada Story Co IA | Mother's Residence |
| Mother's Age | 27 | 1 | Number of Child This Mother |
| Medical Attendant's Name | P.N. Farrar | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | P.N. Farrar | Nevada IA | Certificate Signer's Address |
| Returned by Name | P.N. Farrar | | |