| Certificate Number | 278 | | Date Issued |
| Child Given Name | Anna Marie |
Nelson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 15 Feb 1886 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Christ |
Nelson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Denmark | 21 | Father's Age |
| Mother's Given Name | Lena | Nelson | Mother's Maiden Name |
| Mother's Surname | Nelson | | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | George Stitzell | Nevada IA | Medical Attendant's Address |