| Certificate Number | 257 | | Date Issued |
| Child Given Name | Bessie Rand |
Fifer | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 Oct 1881 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Henry |
Fifer | Father's Surname |
| Father's Occupation | Coal Merchant | American | Father's Nationality |
| Father's Birth Place | Kentucky | 42 | Father's Age |
| Mother's Given Name | Rachel A. | Cobel | Mother's Maiden Name |
| Mother's Surname | Fifer | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 40 | 8 | Number of Child This Mother |
| Medical Attendant's Name | L.C., Mrs. Butt | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | L.C., Mrs. Butt | Nevada IA | Certificate Signer's Address |
| Returned by Name | L.C., Mrs. Butt | | |