| Certificate Number | 316 | | Date Issued |
| Child Given Name | Ole |
Robinson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 20 Jul 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Geo. |
Robinson | Father's Surname |
| Father's Occupation | Mechanic | | Father's Nationality |
| Father's Birth Place | Denmark | 25 | Father's Age |
| Mother's Surname | | Ames 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 | C.A. Beverly | Ames IA | Medical Attendant's Address |