| Certificate Number | 851 | | Date Issued |
| Child Given Name | |
Stigart | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Jan 1884 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | P.R. |
Stigart | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 24 | Father's Age |
| Mother's Given Name | Ada O. | Roker | Mother's Maiden Name |
| Mother's Surname | Stigart | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo. Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo. Stitzell | | |