| Certificate Number | 883 | | Date Issued |
| Child Given Name | Torres |
Ryer | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 Feb 1884 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Torres O. |
Ryer | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 43 | Father's Age |
| Mother's Given Name | Britta | Simonston | Mother's Maiden Name |
| Mother's Surname | Ryer | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 42 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Donna E. Walker | Sheldahl IA | Medical Attendant's Address |
| Certificate Signer's Name | Donna E. Walker | Sheldahl IA | Certificate Signer's Address |
| Returned by Name | Donna E. Walker | | |