| Certificate Number | 76 | | Date Issued |
| Child Given Name | |
Manley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Nov 1880 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Charles |
Manly | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Jones Co IA | 26 | Father's Age |
| Mother's Given Name | Susana | Miller | Mother's Maiden Name |
| Mother's Surname | Manly | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Jones Co IA | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Bradley Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | James Bradey | Ames IA | Certificate Signer's Address |
| Returned by Name | James Bradey | | |