| Certificate Number | 257 | | Date Issued |
| Child Given Name | Edward |
Tvedt | Child Surname |
| Child Sex | Male |
| Child Race |
| Date of Birth | 14 Sep 1881 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Thomas |
Tvedt | Father's Surname |
| Father's Occupation | Farming | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 31 | Father's Age |
| Mother's Given Name | Henn | Sheldahl | Mother's Maiden Name |
| Mother's Surname | Tvedt | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 22 | | Number of Child This Mother |
| Medical Attendant's Name | Betsey Johnson | | Medical Attendant's Address |
| Certificate Signer's Name | Betsey Johnson | | Certificate Signer's Address |
| Returned by Name | Betsey Johnson | | |