| Certificate Number | 608 | | Date Issued |
| Child Given Name | Bell Sophie |
Ike | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Mar 1883 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Hans C.L. |
Ike | Father's Surname |
| Father's Occupation | Laborer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 28 | Father's Age |
| Mother's Given Name | Anna C. | Larson | Mother's Maiden Name |
| Mother's Surname | Ike | | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 30 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Jane L. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | Jane L. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | Jane L. Bartlett | | |