| Certificate Number | 589 | | Date Issued |
| Child Given Name | |
Wier | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 24 Jul 1887 |
| Place of Birth |
| Father's Given Name | W.F. |
Wier | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Mary | Christiansen | Mother's Maiden Name |
| Mother's Surname | | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 24 | 1 | Number of Child This Mother |
| Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |