| Certificate Number | 30 | | Date Issued |
| Child Given Name | |
Hall | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 31 Aug 1880 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | James M. |
Hall | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Iowa | 22 | Father's Age |
| Mother's Given Name | Anna | Osborn | Mother's Maiden Name |
| Mother's Surname | Hall | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Minnesota | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |