| Certificate Number | 153 | | Date Issued |
| Child Given Name | Helen |
Dayton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Mar 1889 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | L.M. |
Dayton | Father's Surname |
| Father's Occupation | Stock Buyer | | Father's Nationality |
| Father's Birth Place | Illinois | 44 | Father's Age |
| Mother's Given Name | Helen A. | White | Mother's Maiden Name |
| Mother's Surname | | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 40 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |