| Certificate Number | 938 | | Date Issued |
| Child Given Name | Floyd M. |
Hadley | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 May 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Samuel |
Hadley | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 31 | Father's Age |
| Mother's Given Name | Clara | Chase | Mother's Maiden Name |
| Mother's Surname | Hadley | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Wisconson | Mother's Birth Place |
| Mother's Age | 26 | 4 | Number of Child This Mother |
| Medical Attendant's Name | L.C., Mrs. Butt | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | L.C., Mrs. Butt | Nevada IA | Certificate Signer's Address |
| Returned by Name | L.C., Mrs. Butt | | |