| Certificate Number | 297 | | Date Issued |
| Child Given Name | Winonia Grace |
Jeffres | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 25 Dec 1881 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | William Hamilton |
Jeffres | Father's Surname |
| Father's Occupation | Blacksmith | American | Father's Nationality |
| Father's Birth Place | Logan OH | 23 | Father's Age |
| Mother's Given Name | Susana A. | Sumners | Mother's Maiden Name |
| Mother's Surname | Jeffres | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | American | La Salle Co IL | Mother's Birth Place |
| Mother's Age | | 2 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton | Zearing IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton | | |