| Certificate Number | 599 | | Date Issued |
| Child Given Name | Anna |
Tolifson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Mar 1883 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Lewis |
Tolifsen | Father's Surname |
| Father's Occupation | Painter | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 22 | Father's Age |
| Mother's Given Name | Mella | Olson | Mother's Maiden Name |
| Mother's Surname | Tolifson | Union 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 | Bertha Thompson | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | Bertha Thompson | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes | | |