| Certificate Number | 55 | | Date Issued |
| Child Given Name | |
Davidson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Dec 1887 |
| Place of Birth |
| Father's Given Name | Lois D. |
Davison | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Denmark | 29 | Father's Age |
| Mother's Given Name | Christine D. | | Mother's Maiden Name |
| Mother's Surname | Davidson | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 27 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |