| Certificate Number | 425 | | Date Issued |
| Child Given Name | |
Hammond | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Oct 1886 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Orange J. |
Hammond | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Canada | 43 | Father's Age |
| Mother's Given Name | Madora | Dunklebarger | Mother's Maiden Name |
| Mother's Surname | Hammond | | Mother's Residence |
| Mother's Nationality | | Pennsylvania | Mother's Birth Place |
| Mother's Age | 36 | 5 | Number of Child This Mother |
| Medical Attendant's Name | George Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | George Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | George Stitzell | | |