| Certificate Number | 164 | | Date Issued |
| Child Given Name | |
Seska | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 01 Apr 1889 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Nels H. |
Seska | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 26 | Father's Age |
| Mother's Given Name | Johana B. | Ostrem | Mother's Maiden Name |
| Mother's Surname | | Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |