| Certificate Number | 79 | | Date Issued |
| Child Given Name | Fred |
Bruner | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 09 Feb 1890 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | W.W. |
Bruner | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 44 | Father's Age |
| Mother's Given Name | Sarah Jane | Houser | Mother's Maiden Name |
| Mother's Surname | Bruner | Sherman Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Pennsylvania | Mother's Birth Place |
| Mother's Age | 39 | 6 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |