| Certificate Number | 547 | | Date Issued |
| Child Given Name | |
Stevenson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 12 Apr 1887 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Stevenson | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | | 38 | Father's Age |
| Mother's Given Name | Lucinda | Gross | Mother's Maiden Name |
| Mother's Surname | Stevenson | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 32 | 6 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |