| Certificate Number | 362 | | Date Issued |
| Child Given Name | Lulu Josephine |
Vinje | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 30 Mar 1882 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | D.J. |
Vinje | Father's Surname |
| Father's Occupation | Attorney at Law | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 32 | Father's Age |
| Mother's Given Name | Helen M. | Huseboe | Mother's Maiden Name |
| Mother's Surname | Vinje | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 27 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Ingeborge D. Vinje | | Medical Attendant's Address |
| Certificate Signer's Name | D.J. Vinje | | Certificate Signer's Address |
| Returned by Name | D.J. Vinje | | |