| Certificate Number | 161 | | Date Issued |
| Child Given Name | Sarah Eugenia |
Keigley | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 03 May 1881 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | Carey B. |
Keigley | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Story Co IA | 24 | Father's Age |
| Mother's Given Name | Augusta M. | Ferguson | Mother's Maiden Name |
| Mother's Surname | Keigley | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | American | Wisconson | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.A. Keigley | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | E.A. Keigley | Ames IA | Certificate Signer's Address |
| Returned by Name | E.A. Keigley | | |