| Certificate Number | 884 | | Date Issued |
| Child Given Name | |
Viland | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 26 Feb 1884 |
Sheldahl Story Co IA | Place of Birth |
| Father's Given Name | Weir P. |
Viland | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 39 | Father's Age |
| Mother's Given Name | Mary A. | Lande | Mother's Maiden Name |
| Mother's Surname | Viland | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 38 | 7 | Number of Child This Mother |
| Medical Attendant's Name | Erick O. Walker | Sheldahl IA | Medical Attendant's Address |
| Certificate Signer's Name | Erick O. Walker | Sheldahl IA | Certificate Signer's Address |
| Returned by Name | W.P. Viland | | |