| Certificate Number | 783 | | Date Issued |
| Child Given Name | |
Hemstock | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 04 Oct 1883 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Thomas |
Hemstock | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Island of Man | 51 | Father's Age |
| Mother's Given Name | Louisa C. | Randal | Mother's Maiden Name |
| Mother's Surname | Hemstock | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 37 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Jessie, Mrs. Barker | | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes | | |