| Certificate Number | 247 | | Date Issued |
| Child Given Name | Edna Chase |
Barker | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Jan 1886 |
Gilbert Station Story Co IA | Place of Birth |
| Father's Given Name | Chas. |
Barker | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 43 | Father's Age |
| Mother's Given Name | Harriet Alcinda | Barker | Mother's Maiden Name |
| Mother's Surname | Barker | | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 39 | 4 | Number of Child This Mother |
| Medical Attendant's Name | A. Marshall | Gilbert Station IA | Medical Attendant's Address |