| Certificate Number | 840 | | Date Issued |
| Child Given Name | Peter Francis |
Hopkins | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 31 Dec 1883 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | P.W. |
Hopkins | Father's Surname |
| Father's Occupation | Lumber Dealer | Irish | Father's Nationality |
| Father's Birth Place | Ireland | 43 | Father's Age |
| Mother's Given Name | Elmira | Hopkins | Mother's Maiden Name |
| Mother's Surname | Hopkins | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | American | Missouri | Mother's Birth Place |
| Mother's Age | 38 | 9 | 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 | | |