| Certificate Number | 325 | | Date Issued |
| Child Given Name | |
Zenor | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 16 Jan 1882 |
Ontario Story Co IA | Place of Birth |
| Father's Given Name | S.S. |
Zenor | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 20 | Father's Age |
| Mother's Given Name | Sarah E. | Scott | Mother's Maiden Name |
| Mother's Surname | Zenor | Ontario Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 18 | 1 | Number of Child This Mother |
| Medical Attendant's Name | G.W. Merrideth M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.W. Merrideth M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | G.W. Merrideth M.D. | | |