| Certificate Number | 313 | | Date Issued |
| Child Given Name | |
Sorsen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 May 1886 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo. H. |
Sorsen | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Denmark | 32 | Father's Age |
| Mother's Given Name | Caroline | Johnson | Mother's Maiden Name |
| Mother's Surname | Sorsen | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |