| Certificate Number | 441 | | Date Issued |
| Child Given Name | Eva |
Zenor | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Oct 1886 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | L. David |
Zenor | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | | 32 | Father's Age |
| Mother's Given Name | Sadie E. | Boone | Mother's Maiden Name |
| Mother's Surname | Zenor | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 30 | 5 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |