| Certificate Number | 293 | | Date Issued |
| Child Given Name | |
Briley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Apr 1886 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Elisha |
Briley | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 50 | Father's Age |
| Mother's Given Name | Mary M. | Foster | Mother's Maiden Name |
| Mother's Surname | Briley | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 42 | 14 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |