| Decedent's Given Name | Andine |
Larsen | Decedent's Surname |
| Location | Lafayette Twp |
200 | Enumeration District |
| Enumerator | Ole O. Roe |
65 | Family Number |
| Age | 1/12 |
F | Sex |
| Color | W |
| Marital Status |
| Birth Place | Iowa |
Norway | Father's Birth Place |
| Mother's Birth Place | Norway |
| Occupation |
| Month of Death | Dec |
Lack of Elimination | Cause of Death |
| How long in Story Co. | |
| Where illness contracted |
| Attending Physician | B.F. Allen |
| Physician's Statement - Primary Cause |
| Physician's Statement - Immediate Cause | Exhaustion |
B.F. Allen | Physician's Signature |
| Enumerator Remarks: | |
The following is not taken from the schedule. See the introduction for an explanation of sources.
| Birth Date | Dec 1879 |
Dec 1879 | Death Date |
| Head of Household Given Name | Anfin J. |
Larsen | Head of Household Surname |
| Grave Marker in Story Co.? | No |
| Cemetery |
| Grave Marker Information: | |
| Transcriber Comments: | |