| Certificate Number | 110 | | Date Issued |
| Child Given Name | David T. |
Ringheim | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 Apr 1888 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | I.A. |
Ringheim | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Norway | 52 | Father's Age |
| Mother's Given Name | Jennie | Sime | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 38 | 7 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |