| Certificate Number | 49 | | Date Issued |
| Child Given Name | |
Mullen | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Dec 1889 |
Richland 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 | Story Co IA | 28 | Father's Age |
| Mother's Given Name | Ella | Farrington | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 26 | 2 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlin | Nevada IA | Medical Attendant's Address |