| Certificate Number | 192 | | Date Issued |
| Child Given Name | Annie |
Sornson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 May 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Geo. M. |
Sornson | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Norway | 34 | Father's Age |
| Mother's Given Name | Bertha | Enson | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 34 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Jane L. Bartlett | Ames IA | Medical Attendant's Address |