| Certificate Number | 821 | | Date Issued |
| Child Given Name | |
Finch | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 Sep 1883 |
| Place of Birth |
| Father's Given Name | D.E. |
Finch | Father's Surname |
| Father's Occupation | Carpenter | American | Father's Nationality |
| Father's Birth Place | Ohio | 64 | Father's Age |
| Mother's Given Name | Casandra | Hizer | Mother's Maiden Name |
| Mother's Surname | Finch | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | | 11 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |