| Certificate Number | 97 | | Date Issued |
| Child Given Name | Hazel |
Lancaster | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Mar 1890 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | Aaron |
Lancaster | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 48 | Father's Age |
| Mother's Given Name | Emma | Green | Mother's Maiden Name |
| Mother's Surname | | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 35 | 6 | Number of Child This Mother |
| Medical Attendant's Name | Z. Cary | Bangor IA | Medical Attendant's Address |