| Certificate Number | 60 | | Date Issued |
| Child Given Name | Wiley Gay |
Hines | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 31 Oct 1880 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | L.W. |
Hines | Father's Surname |
| Father's Occupation | Painter | American | Father's Nationality |
| Father's Birth Place | Ohio | 50 | Father's Age |
| Mother's Given Name | Ellen | Yazell | Mother's Maiden Name |
| Mother's Surname | Hines | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Wisconson | Mother's Birth Place |
| Mother's Age | 25 | 3 | Number of Child This Mother |