| Certificate Number | 314 | | Date Issued |
| Child Given Name | Lillian |
Rasmosen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Jan 1882 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Nels |
Rasmosen | Father's Surname |
| Father's Occupation | Farmer | Dane | Father's Nationality |
| Father's Birth Place | Denmark | 30 | Father's Age |
| Mother's Given Name | Tillie | Miller | Mother's Maiden Name |
| Mother's Surname | Rasmosen | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Boggess M.D. | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | J.W. Boggess M.D. | Nevada IA | Certificate Signer's Address |
| Returned by Name | J.W. Boggess M.D. | | |