| Certificate Number | 221 | | Date Issued |
| Child Given Name | Emma |
Prescott | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 13 Jul 1890 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Knut |
Prescott | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 27 | Father's Age |
| Mother's Given Name | Katie | 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 | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |