| Certificate Number | 1048 | | Date Issued |
| Child Given Name | Mary Frances |
Hopkins | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Sep 1884 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Hopkins | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 32 | Father's Age |
| Mother's Given Name | Mary Jane | McCoy | Mother's Maiden Name |
| Mother's Surname | Hopkins | | Mother's Residence |
| Mother's Nationality | American | Virginia | Mother's Birth Place |
| Mother's Age | 28 | 6 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell | | |