| Certificate Number | 561 | | Date Issued |
| Child Given Name | Harrold Olaf Johan |
Holm | Child Surname |
| Child Sex | |
W | Child Race |
| Date of Birth | 24 May 1887 |
Palestine Twp Story Co iA | Place of Birth |
| Father's Given Name | H.C. |
Holm | Father's Surname |
| Father's Occupation | Minister | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | | Father's Age |
| Mother's Given Name | Carrie | Apland | Mother's Maiden Name |
| Mother's Surname | | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | America | Mother's Birth Place |
| Returned by Name | H.C. Holm | | |