| Certificate Number | 188 | | Date Issued |
| Child Given Name | Richard Herbert |
Hopkins | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 16 Jun 1881 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Peter W. |
Hopkins | Father's Surname |
| Father's Occupation | Lumber Dealer | | Father's Nationality |
| Father's Birth Place | Ireland | 41 | Father's Age |
| Mother's Given Name | Elmira | 'not changed' | Mother's Maiden Name |
| Mother's Surname | Hopkins | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Missouri | Mother's Birth Place |
| Mother's Age | 36 | 8 | Number of Child This Mother |
| Medical Attendant's Name | Phebe Hopkins | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Phebe Hopkins | Colo IA | Certificate Signer's Address |
| Returned by Name | Phebe Hopkins | | |