| Certificate Number | 917 | | Date Issued |
| Child Given Name | James |
Sorguson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 21 Dec 1883 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | George M. |
Sorenson | Father's Surname |
| Father's Occupation | Section Hand | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 28 | Father's Age |
| Mother's Given Name | Bertha | Enson | Mother's Maiden Name |
| Mother's Surname | Sorenson | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 28 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.L. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J.L. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | J.L. Bartlett | | |