| Certificate Number | 227 | | Date Issued |
| Child Given Name | Oscar Cornelius |
Prescott | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 05 Feb 1890 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Ole |
Prescott | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 25 | Father's Age |
| Mother's Given Name | Mary | Simonson | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |