| Certificate Number | 481 | | Date Issued |
| Child Given Name | |
Hanison | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 20 May 1882 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | David |
Harrison | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Martha Matilda | Spencer | Mother's Maiden Name |
| Mother's Surname | Harrison | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | James Bradley | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | James Bradley | Ames IA | Certificate Signer's Address |
| Returned by Name | James Bradley | | |