| Certificate Number | 89 | | Date Issued |
| Child Given Name | |
Hanson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 Feb 1890 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | Ole |
Hanson | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Norway | 42 | Father's Age |
| Mother's Given Name | Ida | Erickson | Mother's Maiden Name |
| Mother's Surname | | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Roland Story Co IA | Mother's Birth Place |
| Mother's Age | 28 | 7 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Peterson | Story City IA | Medical Attendant's Address |