| Certificate Number | 601 | | Date Issued |
| Child Given Name | Carl Amber |
Hague | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 23 Mar 1883 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Newton |
Hauge | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 23 | Father's Age |
| Mother's Given Name | Nellie B. | Aldeman | Mother's Maiden Name |
| Mother's Surname | Hauge | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 18 | 1 | 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 | E.H. Munk | | |