| Certificate Number | 170 | | Date Issued |
| Child Given Name | Anna |
Sorensen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 May 1890 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Rasmus |
Sorenson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Denmark | 43 | Father's Age |
| Mother's Given Name | Mary | Davidson | Mother's Maiden Name |
| Mother's Surname | | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |