| Certificate Number | 1012 | | Date Issued |
| Child Given Name | Bertha Kondina |
Vinje | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Jul 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | David J. |
Vinje | Father's Surname |
| Father's Occupation | Attorney at Law | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 34 | Father's Age |
| Mother's Given Name | Hellen M. | Russbo | Mother's Maiden Name |
| Mother's Surname | Vine | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 29 | 4 | Number of Child This Mother |
| Medical Attendant's Name | D.J. Vinje | | Medical Attendant's Address |