| Certificate Number | 318 | | Date Issued |
| Child Given Name | Edwin Augustine |
Rignheim | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 06 Jan 1882 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | I.A. |
Ringheim | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Mother's Given Name | Jennie | Simes | Mother's Maiden Name |
| Mother's Surname | Ringheim | Nevada Story Co IA | Mother's Residence |
| Mother's Age | | 4 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk M.D. | | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Monk M.D. | | Certificate Signer's Address |
| Returned by Name | E.H. Monk M.D. | | |