| Certificate Number | 165 | | Date Issued |
| Child Given Name | |
Hannegan | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 Jul 1885 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | William |
Hannegan | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 24 | Father's Age |
| Mother's Given Name | Flora J. | McFarland | Mother's Maiden Name |
| Mother's Surname | Hannegan | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 22 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |