| Certificate Number | 231 | | Date Issued |
| Child Given Name | Carl Olis |
Torgerson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 Dec 1885 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Abraham |
Torgorson | Father's Surname |
| Father's Occupation | Coal Heaver | | Father's Nationality |
| Father's Birth Place | Norway | 31 | Father's Age |
| Mother's Given Name | Sarah | Oleson | Mother's Maiden Name |
| Mother's Surname | | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 27 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Read | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | Mrs. Read | Cambridge IA | Certificate Signer's Address |
| Returned by Name | Mrs. Read | | |