| Certificate Number | 751 | | Date Issued |
| Child Given Name | Harry Davis |
Baker | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 22 Sep 1883 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Levi Frank |
Baker | Father's Surname |
| Father's Occupation | Barber | American | Father's Nationality |
| Father's Birth Place | Illinois | 30 | Father's Age |
| Mother's Given Name | Eliza M. | Davis | Mother's Maiden Name |
| Mother's Surname | Baker | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell | | |