| Certificate Number | 56 | | Date Issued |
| Child Given Name | Hattie M. |
Ballow | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Oct 1880 |
Frank McLain place | Place of Birth |
| Father's Given Name | James E. |
Ballow | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Miss | 30 | Father's Age |
| Mother's Given Name | Mattie M. | Ballow | Mother's Maiden Name |
| Mother's Surname | Ballow | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Rhode Island | Mother's Birth Place |
| Mother's Age | 39 | 2 | 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 | 'mail' | | |