| Certificate Number | 65 | | Date Issued |
| Child Given Name | Julius A. |
Burkland | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 22 Nov 1887 |
Sheldahl Story Co IA | Place of Birth |
| Father's Given Name | Michael |
Burkland | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Norway | 23 | Father's Age |
| Mother's Given Name | L. | Howick | Mother's Maiden Name |
| Mother's Surname | Burkland | Sheldahl Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Anderson | Sheldahl IA | Medical Attendant's Address |