| Certificate Number | 153 | | Date Issued |
| Child Given Name | Amanda |
Hendrickson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 15 May 1890 |
Howard Twp Story Co IA | Place of Birth |
| Father's Given Name | Hendrick |
Hendrickson | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Norway | 24 | Father's Age |
| Mother's Given Name | Ingeborg | Twedt | Mother's Maiden Name |
| Mother's Surname | | Howard Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Martine Tuttle | Milford Twp IA | Medical Attendant's Address |