| Certificate Number | 27 | | Date Issued |
| Child Given Name | |
Westman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Aug 1880 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Andrew |
Westman | Father's Surname |
| Father's Occupation | Laborer | Swedish | Father's Nationality |
| Father's Birth Place | Sweden | 27 | Father's Age |
| Mother's Given Name | Susannah | Pitsurburg | Mother's Maiden Name |
| Mother's Surname | Westman | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 3 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Meridith | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Meridith | Ames IA | Certificate Signer's Address |
| Returned by Name | 'mail' | | |