| Certificate Number | 32 | | Date Issued |
| Child Given Name | Martin |
Roe | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 05 Nov 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Ole O. |
Roe | Father's Surname |
| Father's Occupation | Supt of Schools | | Father's Nationality |
| Father's Birth Place | | 33 | Father's Age |
| Mother's Given Name | Sarah O. | Olson | Mother's Maiden Name |
| Mother's Surname | Roe | Nevada Story Co IA | Mother's Residence |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |