| Child Given Name | Gertrude Augusta |
Lein | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 01 Sep 1887 |
Roland Story Co IA | Place of Birth |
| Father's Given Name | Thomas A. |
Lein | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Skaanevig Norway | 57 | Father's Age |
| Mother's Given Name | Christina | Engebritson | Mother's Maiden Name |
| Mother's Surname | Lein | Roland Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Hallingdahl Norway | Mother's Birth Place |
| Mother's Age | 39 | | Number of Child This Mother |
| Medical Attendant's Name | Valbor, Mrs. Olson | | Medical Attendant's Address |
| Certificate Signer's Name | Valbor, Mrs. Olson | | Certificate Signer's Address |
| Returned by Name | Valbor, Mrs. Olson | | |