| Certificate Number | 349 | | Date Issued |
| Child Given Name | Hazel Belle |
Morris | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Aug 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | John |
Morris | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 25 | Father's Age |
| Mother's Given Name | Delilah Alice | See | Mother's Maiden Name |
| Mother's Surname | | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 26 | 2 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |