| Certificate Number | 464 | | Date Issued |
| Child Given Name | William |
Hallowell | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 Aug 1886 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | James |
Hallowell | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Canada | 51 | Father's Age |
| Mother's Given Name | James | Koin | Mother's Maiden Name |
| Mother's Surname | Hallowell | Story Co IA | Mother's Residence |
| Mother's Nationality | | Ireland | Mother's Birth Place |
| Mother's Age | 43 | 10 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Koin | Nevada IA | Medical Attendant's Address |
| Returned by Name | E.H. Monk | | |