| Certificate Number | 171 | | Date Issued |
| Child Given Name | |
Halley | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 17 Feb 1890 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Joseph |
Halley | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 36 | Father's Age |
| Mother's Given Name | Mildred | Hague | Mother's Maiden Name |
| Mother's Surname | | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |