| Certificate Number | 1051 | | Date Issued |
| Child Given Name | |
Hoyman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 15 May 1884 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo. W. |
Hoyman | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 27 | Father's Age |
| Mother's Given Name | Flora A. | White | Mother's Maiden Name |
| Mother's Surname | Hoyman | | Mother's Residence |
| Mother's Nationality | | Tennessee | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell | | |