| Certificate Number | 51 | | Date Issued |
| Child Given Name | Maggia Bell |
Lemon | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Dec 1884 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | John W. |
Lemon | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Mary | Harrison | Mother's Maiden Name |
| Mother's Surname | Lemon | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 22 | 3 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hays | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hays | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hays | | |