| Certificate Number | 188 | | Date Issued |
| Child Given Name | |
Stanfield | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 16 Nov 1885 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | D.L. |
Stanfield | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Lynn Co IA | 31 | Father's Age |
| Mother's Given Name | Mary C. | Davis | Mother's Maiden Name |
| Mother's Surname | Stanfield | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Marshall Co IA | Mother's Birth Place |
| Mother's Age | 29 | 4 | 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 | | |