| Certificate Number | 428 | | Date Issued |
| Child Given Name | Silvana |
Olson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Aug 1882 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Ole O. |
Olsen | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 31 | Father's Age |
| Mother's Given Name | Laura E. | Olsen | Mother's Maiden Name |
| Mother's Surname | Olsen | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 4 | Number of Child This Mother |
| Medical Attendant's Name | N. Robinson M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | N. Robinson M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | N. Robinson | | |