| Certificate Number | 93 | | Date Issued |
| Child Given Name | Emma Isablla |
Mathre | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 26 Feb 1888 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | P. |
Mathre | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Illinois | 32 | Father's Age |
| Mother's Given Name | Elsie | Ellingson | Mother's Maiden Name |
| Mother's Surname | | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 27 | 3 | Number of Child This Mother |
| Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |