| Certificate Number | 151 | | Date Issued |
| Child Given Name | Johan M. |
Hansen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 17 May 1890 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Christian |
Hansen | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Denmark | 33 | Father's Age |
| Mother's Given Name | Marie | Olsen | Mother's Maiden Name |
| Mother's Surname | | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Martine Tuttle | Milford Twp IA | Medical Attendant's Address |