| Certificate Number | 608 | | Date Issued |
| Child Given Name | |
Rasmusson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 14 May 1887 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Rasmus |
Rasmusson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Denmark | 26 | Father's Age |
| Mother's Given Name | Anna | Johnson | Mother's Maiden Name |
| Mother's Surname | Rasmusson | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 22 | 2 | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |