| Certificate Number | 230 | | Date Issued |
| Child Given Name | |
Swanson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 Aug 1889 |
Gilbert Story Co IA | Place of Birth |
| Father's Given Name | Noah |
Swanson | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Sweden | 40 | Father's Age |
| Mother's Given Name | Lucy | Crammer | Mother's Maiden Name |
| Mother's Surname | | Gilbert Story Co IA | Mother's Residence |
| Mother's Nationality | | Dallas Co IA | Mother's Birth Place |
| Mother's Age | 30 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Rachel Marshall | Gilbert IA | Medical Attendant's Address |