| Certificate Number | 188 | | Date Issued |
| Child Given Name | George M. |
Britten | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Jul 1890 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | William |
Britten | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ireland | 25 | Father's Age |
| Mother's Given Name | Eliza | Nilley | Mother's Maiden Name |
| Mother's Surname | | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg IA | Medical Attendant's Address |