| Certificate Number | 107 | | Date Issued |
| Child Given Name | James Warren |
Bryant | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Mar 1888 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo. |
Bryant | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 35 | Father's Age |
| Mother's Given Name | Margaret S. | See | Mother's Maiden Name |
| Mother's Surname | Bryant | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 31 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |