| Certificate Number | 287 | | Date Issued |
| Child Given Name | |
Thompson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 Feb 1886 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Thom |
Thomson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 36 | Father's Age |
| Mother's Given Name | Bertha O. | Olson | Mother's Maiden Name |
| Mother's Surname | Thompson | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 30 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |