| Certificate Number | 541 | | Date Issued |
| Child Given Name | David H. |
Hoadley | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Dec 1882 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Morgan |
Hoadley | Father's Surname |
| Father's Occupation | Carpenter | American | Father's Nationality |
| Father's Birth Place | New York | 39 | Father's Age |
| Mother's Given Name | Laurna? | Edgett | Mother's Maiden Name |
| Mother's Surname | Hoadley | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 32 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Jno I. Hostetter | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno I. Hostetter | Nevada IA | Certificate Signer's Address |
| Returned by Name | Jno I. Hostetter | | |