| Certificate Number | 185 | | Date Issued |
| Child Given Name | C. Sidney |
Mullen | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 18 Sep 1885 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Henry W. |
Mullen | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Nevada Twp Story Co IA | 22 | Father's Age |
| Mother's Given Name | Ella | Farrington | Mother's Maiden Name |
| Mother's Surname | Mullen | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E. Hennick | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E. Hennick | Nevada IA | Certificate Signer's Address |
| Returned by Name | E. Hennick | | |