| Certificate Number | 203 | | Date Issued |
| Child Given Name | Edith Belle |
Stevens | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 Jul 1888 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | S.B. |
Stevens | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 40 | Father's Age |
| Mother's Given Name | Nettie | Hanks | Mother's Maiden Name |
| Mother's Surname | | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 22 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J.R., Mrs. Sassady | | Medical Attendant's Address |