| Certificate Number | 782 | | Date Issued |
| Child Given Name | Floyd Bryant |
Spencer | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 02 Oct 1883 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | George H. |
Spencer | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Marietta OH | 30 | Father's Age |
| Mother's Given Name | Almatia L. | Bryant | Mother's Maiden Name |
| Mother's Surname | Bryant | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Palestine Twp Story Co IA | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J. Bradley | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J. Bradley | Ames IA | Certificate Signer's Address |
| Returned by Name | J. Bradley | | |