| Certificate Number | 204 | | Date Issued |
| Child Given Name | Howard Templeton |
Hill | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 18 May 1889 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Ole T. |
Hill | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 32 | Father's Age |
| Mother's Given Name | Nettie T. | Templeton | Mother's Maiden Name |
| Mother's Surname | | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 34 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |