| Certificate Number | 85 | | Date Issued |
| Child Given Name | Sarah A. |
Breezley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Jan 1889 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | W.H. |
Breezley | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Cambridge IA | 32 | Father's Age |
| Mother's Given Name | Martha A. | Sharp | Mother's Maiden Name |
| Mother's Surname | | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Faribault Co MN | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |