| Certificate Number | 37 | | Date Issued |
| Child Given Name | |
Stillman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 15 Dec 1887 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | E.O. |
Stillman | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | New York | 40 | Father's Age |
| Mother's Given Name | C.A. | Hemstock | Mother's Maiden Name |
| Mother's Surname | Stillman | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 34 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffrey | Nevada IA | Medical Attendant's Address |