| Certificate Number | 288 | | Date Issued |
| Child Given Name | Clara F. |
Lyman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Dec 1885 |
| Place of Birth |
| Father's Given Name | W.F. |
Lyman | Father's Surname |
| Father's Occupation | Tile dealer | | Father's Nationality |
| Father's Birth Place | Alabama | 29 | Father's Age |
| Mother's Given Name | Mary E. | Rice | Mother's Maiden Name |
| Mother's Surname | Lyman | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 30 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |