| Certificate Number | 235 | | Date Issued |
| Child Given Name | Zenia George |
Stillman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 09 Nov 1885 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | E.O. |
Stillman | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 37 | Father's Age |
| Mother's Given Name | Annetta | Hemstock | Mother's Maiden Name |
| Mother's Surname | Stillman | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 32 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |