| Certificate Number | 338 | | Date Issued |
| Child Given Name | Henry Grover |
Alderman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 30 Jun 1886 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Silas P. |
Alderman | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Mother's Given Name | Sarah Jane | Ellison | Mother's Maiden Name |
| Mother's Surname | Alderman | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Age | | 4 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |