| Certificate Number | 202 | | Date Issued |
| Child Given Name | Ethel M. |
Foiles | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 27 Oct 1888 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | Edward W. |
Foiles | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | DeKalb Co IL | 30 | Father's Age |
| Mother's Given Name | Mary | Benges | Mother's Maiden Name |
| Mother's Surname | | Story Co IA | Mother's Residence |
| Mother's Nationality | | DuPage Co IL | Mother's Birth Place |
| Mother's Age | 27 | 3 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |