| Decedent's Given Name | Severin |
Andersen | Decedent's Surname |
| Location | Lafayette Twp |
200 | Enumeration District |
| Enumerator | Ole O. Roe |
178 | Family Number |
| Age | 3/12 |
M | Sex |
| Color | W |
| Marital Status |
| Birth Place | Iowa |
Norway | Father's Birth Place |
| Mother's Birth Place | Norway |
| Occupation |
| Month of Death | Aug |
| Cause of Death |
| How long in Story Co. | 3/12 |
| Where illness contracted |
| Attending Physician | |
| Physician's Statement - Primary Cause |
| Physician's Statement - Immediate Cause | |
| Physician's Signature |
| Enumerator Remarks: | |
The following is not taken from the schedule. See the introduction for an explanation of sources.
| Birth Date | May 1879 |
Aug 1879 | Death Date |
| Head of Household Given Name | Soren |
Anderson | Head of Household Surname |
| Grave Marker in Story Co.? | No |
| Cemetery |
| Grave Marker Information: | |
| Transcriber Comments: | |