| Certificate Number | 91 | | Date Issued |
| Child Given Name | Zadie A. |
Nerness | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Jan 1889 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Zachariah |
Nerness | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 26 | Father's Age |
| Mother's Given Name | Anna S. | Olsen | Mother's Maiden Name |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 25 | 6 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |