| Certificate Number | 277 | | Date Issued |
| Child Given Name | Harry S. |
Funson | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 09 Aug 1881 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Hugh M. |
Funson | Father's Surname |
| Father's Occupation | Attorney | American | Father's Nationality |
| Father's Birth Place | Philadelphia PA | 27 | Father's Age |
| Mother's Given Name | Ella | Shugart | Mother's Maiden Name |
| Mother's Surname | Funson | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Bureau Co IL | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | P.W. Farrar | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | P.W. Farrar | Nevada IA | Certificate Signer's Address |
| Returned by Name | P.W. Farrar | | |