| Certificate Number | 39 | | Date Issued |
| Child Given Name | |
Hanks | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 07 Nov 1888 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm E. |
Hanks | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 38 | Father's Age |
| Mother's Given Name | Mary E. | McHone | Mother's Maiden Name |
| Mother's Surname | | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 32 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |