| Certificate Number | 361 | | Date Issued |
| Child Given Name | Wilas A. |
Hamlin | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 28 Mar 1882 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Andrew J. |
Hamlin | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 38 | Father's Age |
| Mother's Given Name | Sarah E. | Groseclose | Mother's Maiden Name |
| Mother's Surname | Hamlin | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 30 | 8 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hays | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hays | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hays | | |