| Certificate Number | 246 | | Date Issued |
| Child Given Name | Hazel Bell Alice |
Skelton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 Sep 1890 |
Gilbert Station Story Co IA | Place of Birth |
| Father's Given Name | Joseph |
Skelton | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 39 | Father's Age |
| Mother's Given Name | Cerelda A. | Jackson | Mother's Maiden Name |
| Mother's Surname | | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 29 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Rachel Marshall | Gilbert Station IA | Medical Attendant's Address |