| Certificate Number | 568 | | Date Issued |
| Child Given Name | |
Hanks | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 May 1887 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Dewitt Clinton |
Hanks | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 38 | Father's Age |
| Mother's Given Name | Comfort | Leman | Mother's Maiden Name |
| Mother's Surname | Hanks | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 34 | 4 | Number of Child This Mother |
| Medical Attendant's Name | W.H. Aplin | Cambridge IA | Medical Attendant's Address |