| Certificate Number | 70 | | Date Issued |
| Child Given Name | Hannah |
Holm | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Sep 1888 |
Howard Twp Story Co IA | Place of Birth |
| Father's Given Name | John J. |
Holm | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 41 | Father's Age |
| Mother's Given Name | Caroline | Jacobson | Mother's Maiden Name |
| Mother's Surname | | Howard Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 33 | 5 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |