| Certificate Number | 149 | | Date Issued |
| Child Given Name | |
Stephens | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 01 Mar 1890 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Zimri |
Stephens | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 48 | Father's Age |
| Mother's Given Name | Mary J. | Quinnette | Mother's Maiden Name |
| Mother's Surname | | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 46 | 11 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |