| Certificate Number | 7 | | Date Issued |
| Child Given Name | |
Olson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Jul 1891 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo. C. |
Olson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 24 | Father's Age |
| Mother's Given Name | Jennie E. | Vandelinder | Mother's Maiden Name |
| Mother's Surname | Olson | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | A. Richmond M.D. | Ames IA | Medical Attendant's Address |