| Child Given Name | Blanche Olive |
Hall | Child Surname |
| Child Sex | |
W | Child Race |
| Date of Birth | 07 Aug 1885 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Franklin Lee |
Hall | Father's Surname |
| Father's Occupation | Farming | American | Father's Nationality |
| Father's Birth Place | Maxwell Story Co IA | 23 | Father's Age |
| Mother's Given Name | Clara Lourinda | John | Mother's Maiden Name |
| Mother's Surname | | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | American | Maxwell Story Co IA | Mother's Birth Place |
| Mother's Age | 23 | | Number of Child This Mother |
| Medical Attendant's Name | P., Dr. Joor | | Medical Attendant's Address |
| Certificate Signer's Name | Alice Hall Wood | | Certificate Signer's Address |