| Certificate Number | 321 | | Date Issued |
| Child Given Name | Virgil Marton |
Zenor | Child Surname |
| Child Sex | |
W | Child Race |
| Date of Birth | 01 Sep 1889 |
Gilbert Story Co IA | Place of Birth |
| Father's Given Name | Clifford |
Zenor | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Iowa | 21 | Father's Age |
| Mother's Given Name | Ettie | Canady | Mother's Maiden Name |
| Mother's Surname | | Gilbert Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 18 | | Number of Child This Mother |
| Medical Attendant's Name | Merchant Zenor | Ames IA | Medical Attendant's Address |