| Certificate Number | 228 | | Date Issued |
| Child Given Name | Zella |
White | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Nov 1889 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Lyman E. |
White | Father's Surname |
| Father's Occupation | Hdwre Merchant | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 40 | Father's Age |
| Mother's Given Name | Hattie | Gardner | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 34 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |