| Certificate Number | 380 | | Date Issued |
| Child Given Name | |
Bryant | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 18 Feb 1882 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Robt |
Bryant | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 45 | Father's Age |
| Mother's Given Name | Eliza | Pearce | Mother's Maiden Name |
| Mother's Surname | Bryant | | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 38 | 4 | Number of Child This Mother |
| Medical Attendant's Name | P.W. Farrar M.D. | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | P.W. Farrar M.D. | Nevada IA | Certificate Signer's Address |
| Returned by Name | P.W. Farrar M.D. | | |