| Certificate Number | 20 | | Date Issued |
| Child Given Name | Abraham Ellis |
Hiatt | Child Surname |
| Child Sex | Male |
A | Child Race |
| Date of Birth | 19 Jul 1880 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | William E. |
Hiatt | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | | Father's Age |
| Mother's Given Name | Priscilla | Staley | Mother's Maiden Name |
| Mother's Surname | Hiatt | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | | 1 | Number of Child This Mother |