| Certificate Number | 987 | | Date Issued |
| Child Given Name | Zell |
Stephens | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Jul 1884 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | C.C. |
Stephens | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 33 | Father's Age |
| Mother's Given Name | Florence K. | Gossard | Mother's Maiden Name |
| Mother's Surname | Stephens | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merrideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merrideth | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merrideth | | |