| Certificate Number | 224 | | Date Issued |
| Child Given Name | Anna C. |
Nelson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 24 Aug 1890 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Ole |
Nelson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Denmark | 48 | Father's Age |
| Mother's Given Name | Pauline | Nelson | Mother's Maiden Name |
| Mother's Surname | | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 36 | 6 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Ichorn | | Medical Attendant's Address |
| Returned by Name | E.H. Monk | | |