| Certificate Number | 170 | | Date Issued |
| Child Given Name | Malinda S. |
Reirson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Jul 1885 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Lewis |
Rierson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 43 | Father's Age |
| Mother's Given Name | Elizabeth | Johnson | Mother's Maiden Name |
| Mother's Surname | | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 37 | 10 | Number of Child This Mother |
| Medical Attendant's Name | Frank Thompson M.D. | Iowa Center IA | Medical Attendant's Address |
| Certificate Signer's Name | Frank Thompson M.D. | Iowa Center IA | Certificate Signer's Address |
| Returned by Name | Frank Thompson M.D. | | |