| Certificate Number | 594 | | Date Issued |
| Child Given Name | Ruth |
Dyer | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Jul 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Geo. W. |
Dyer | Father's Surname |
| Father's Occupation | Attorney At Law | | Father's Nationality |
| Father's Birth Place | New York | 47 | Father's Age |
| Mother's Given Name | Martha | Kellogg | Mother's Maiden Name |
| Mother's Surname | Dyer | | Mother's Residence |
| Mother's Nationality | | Nevada Story Co IA | Mother's Birth Place |
| Mother's Age | 30 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffrey | Nevada IA | Medical Attendant's Address |