| Certificate Number | 980 | | Date Issued |
| Child Given Name | Bertha |
Hemstreet | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 20 Jun 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Albert N. |
Hemstreet | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 27 | Father's Age |
| Mother's Given Name | Delia S. | Thayer | Mother's Maiden Name |
| Mother's Surname | Hemstreet | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 21 | 2 | Number of Child This Mother |
| Medical Attendant's Name | P.W. Farrar | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | P.W. Farrar | Nevada IA | Certificate Signer's Address |
| Returned by Name | P.W. Farrar | | |