| Certificate Number | 581 | | Date Issued |
| Child Given Name | Bertha Gurine |
Tesdahl | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Mar 1883 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Oliver L. |
Tesdahl | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Martha C. | Johnsen | Mother's Maiden Name |
| Mother's Surname | Tesdahl | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 22 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Lackus | Palestine Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Mrs. Lackus | Palestine Twp IA | Certificate Signer's Address |
| Returned by Name | Oliver L. Tesdahl | | |