| Certificate Number | 440 | | Date Issued |
| Child Given Name | Randy Malinda |
Nelson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Aug 1882 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Joseph L. |
Nelson | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Illinois | 29 | Father's Age |
| Mother's Given Name | Sarah L. | Thompson | Mother's Maiden Name |
| Mother's Surname | Nelson | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Illinois | Mother's Birth Place |
| Mother's Age | 30 | 4 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hays M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hays M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hays M.D. | | |