| Certificate Number | 839 | | Date Issued |
| Child Given Name | |
Hux | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 22 Dec 1883 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Joseph |
Hux | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Keokuk Co IA | 22 | Father's Age |
| Mother's Given Name | Mary | McClung | Mother's Maiden Name |
| Mother's Surname | Hux | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Keokuk Co iA | Mother's Birth Place |
| Mother's Age | 17 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Phoebe Hopkins | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Phoebe Hopkins | Colo IA | Certificate Signer's Address |
| Returned by Name | Phoebe Hopkins | | |