| Certificate Number | 808 | | Date Issued |
| Child Given Name | |
Newhard | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Oct 1883 |
Worth Twp Boone Co IA | Place of Birth |
| Father's Given Name | Cyrus |
Newhard | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Jones Co IA | 27 | Father's Age |
| Mother's Given Name | Jennie | Hokes | Mother's Maiden Name |
| Mother's Surname | Newhard | Worth Twp Boone Co IA | Mother's Residence |
| Mother's Nationality | American | Jones Co IA | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |