| Certificate Number | 23 | | Date Issued |
| Child Given Name | |
Stitzell | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 04 Nov 1887 |
Gilbert Station Story Co IA | Place of Birth |
| Father's Given Name | G.A. |
Stitzell | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 28 | Father's Age |
| Mother's Given Name | Victoria | Marshall | Mother's Maiden Name |
| Mother's Surname | | Gilbert Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Rachel Marshal | Gilbert IA | Medical Attendant's Address |