| Certificate Number | 104 | | Date Issued |
| Child Given Name | Sarah |
Reed | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 14 Feb 1890 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | J.F. |
Reed | Father's Surname |
| Father's Occupation | Teacher | | Father's Nationality |
| Father's Birth Place | Iowa | 26 | Father's Age |
| Mother's Given Name | Emma | Oakes | Mother's Maiden Name |
| Mother's Surname | | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 24 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.W. Brooks | Zearing IA | Medical Attendant's Address |