| Certificate Number | 47 | | Date Issued |
| Child Given Name | Mary Marie |
Rasmussen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 13 Dec 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Lars |
Rasmusson | Father's Surname |
| Father's Occupation | Teamster | | Father's Nationality |
| Father's Birth Place | Denmark | 25 | Father's Age |
| Mother's Given Name | Christena | Rasmussen | Mother's Maiden Name |
| Mother's Surname | Rasmussen | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |