| Certificate Number | 1025 | | Date Issued |
| Child Given Name | Harvey Nelson |
Taylor | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 Sep 1884 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | C.E. |
Taylor | Father's Surname |
| Father's Occupation | Billiards Saloon | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 32 | Father's Age |
| Mother's Given Name | Nancy | Wilder | Mother's Maiden Name |
| Mother's Surname | Taylor | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | | 3 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | C.A. Beverly | Ames IA | Certificate Signer's Address |
| Returned by Name | C.A. Beverly | | |