| Certificate Number | 627 | | Date Issued |
| Child Given Name | |
Stoops | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | David R. |
Stoop | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Carroll Co IN | 45 | Father's Age |
| Mother's Given Name | Effie A. | Davis | Mother's Maiden Name |
| Mother's Surname | Stoop | Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 32 | 5 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |