| Certificate Number | 352 | | Date Issued |
| Child Given Name | Hugh |
Graef | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Aug 1889 |
| Place of Birth |
| Father's Given Name | Fred |
Graef | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 21 | Father's Age |
| Mother's Given Name | Elizabeth | Dodd | Mother's Maiden Name |
| Mother's Surname | | Collins Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 18 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.P. Edgar | Collins IA | Medical Attendant's Address |