| Certificate Number | 171 | | Date Issued |
| Child Given Name | Manerva Elizabeth |
Bradley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Aug 1885 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Ariel B. |
Bradley | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 30 | Father's Age |
| Mother's Given Name | Ella | Brewbaker | Mother's Maiden Name |
| Mother's Surname | Bradley | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 28 | 1 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton M.D. | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton M.D. | Zearing IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton M.D. | | |