| Certificate Number | 174 | | Date Issued |
| Child Given Name | Harold Elton |
Gretten | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Aug 1885 |
Gilbert Station Story Co IA | Place of Birth |
| Father's Given Name | Michael |
Gretten | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Germany | 44 | Father's Age |
| Mother's Given Name | Hannah | Ruth | Mother's Maiden Name |
| Mother's Surname | Gretten | Gilbert Station Story Co IA | Mother's Residence |
| Mother's Nationality | | Lake Co IL | Mother's Birth Place |
| Mother's Age | 41 | 9 | Number of Child This Mother |
| Medical Attendant's Name | Rachael Marshall | Gilbert Station IA | Medical Attendant's Address |
| Certificate Signer's Name | Rachael Marshall | Gilbert Station IA | Certificate Signer's Address |
| Returned by Name | Rachael Marshall | | |