| Certificate Number | 38 | | Date Issued |
| Child Given Name | |
Jondal | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Dec 1887 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | E.H. |
Jondall | Father's Surname |
| Father's Occupation | Bager | | Father's Nationality |
| Father's Birth Place | Norway | 35 | Father's Age |
| Mother's Given Name | | Pederson | Mother's Maiden Name |
| Mother's Surname | | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 27 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Anna G. Tokheim | Story City IA | Medical Attendant's Address |