| Certificate Number | 90 | | Date Issued |
| Child Given Name | Helen |
Hague | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 28 Jan 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Louis H. |
Hague | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 28 | Father's Age |
| Mother's Given Name | Julia | Hendrickson | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 27 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A. Richmond | Ames IA | Medical Attendant's Address |