| Certificate Number | 426 | | Date Issued |
| Child Given Name | Osker Leir |
Severson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Jul 1882 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Severt J. |
Severson | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Iowa | 24 | Father's Age |
| Mother's Given Name | Isabell | Severson | Mother's Maiden Name |
| Mother's Surname | Sheldahl | | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 24 | 3 | Number of Child This Mother |
| Certificate Signer's Name | Anna, Mrs. Reed | | Certificate Signer's Address |