| Certificate Number | 46 | | Date Issued |
| Child Given Name | Sina M.K. |
Haaland | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Nov 1889 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Sol. J. |
Haaland | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 34 | Father's Age |
| Mother's Given Name | Carrie O. | Sheffland | Mother's Maiden Name |
| Mother's Surname | | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 28 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Lizzie O. Sheffland | Cambridge IA | Medical Attendant's Address |