| Certificate Number | 301 | | Date Issued |
| Child Given Name | |
Amlund | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 May 1886 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | Gustave |
Amlund | Father's Surname |
| Father's Occupation | Blacksmith | | Father's Nationality |
| Father's Birth Place | Norway | | Father's Age |
| Mother's Surname | | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 31 | 7 | Number of Child This Mother |
| Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |