| Certificate Number | 36 | | Date Issued |
| Child Given Name | Rose |
Lancaster | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Jul 1886 |
Near Zearing Story Co IA | Place of Birth |
| Father's Given Name | Elwood |
Lancaster | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 31 | Father's Age |
| Mother's Given Name | Alma A. | Sawin | Mother's Maiden Name |
| Mother's Surname | Lancaster | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Z. Corey | Bangor IA | Medical Attendant's Address |
| Certificate Signer's Name | Z. Corey | Bangor IA | Certificate Signer's Address |
| Returned by Name | Z. Corey | | |