| Certificate Number | 482 | | Date Issued |
| Child Given Name | |
Hall | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Dec 1882 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Henry Hasekll |
Hall | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Connecticut | 33 | Father's Age |
| Mother's Given Name | Carie Louisa | Larson | Mother's Maiden Name |
| Mother's Surname | Hall | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Connecticut | Mother's Birth Place |
| Mother's Age | 33 | 1 | Number of Child This Mother |
| Medical Attendant's Name | James Bradley | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | James Bradley | Ames IA | Certificate Signer's Address |
| Returned by Name | James Bradley | | |