| Certificate Number | 154 | | Date Issued |
| Child Given Name | |
Hyden | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 17 Mar 1881 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo |
Hyden | Father's Surname |
| Father's Occupation | Farmer | Englishman | Father's Nationality |
| Father's Birth Place | England | 52 | Father's Age |
| Mother's Given Name | Louisa | Hyden | Mother's Maiden Name |
| Mother's Surname | Pool | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 37 | 7 | Number of Child This Mother |
| Medical Attendant's Name | Lewis Schooler | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Lewis Schooler | Nevada IA | Certificate Signer's Address |
| Returned by Name | Lewis Schooler | | |