| Certificate Number | 532 | | Date Issued |
| Child Given Name | Etta May |
Westman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 25 Mar 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Adrian |
Westman | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Sweden | 34 | Father's Age |
| Mother's Given Name | Susie | Pitsenberg | Mother's Maiden Name |
| Mother's Surname | Westman | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Jones Co IA | Mother's Birth Place |
| Mother's Age | 30 | 6 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |