| Certificate Number | 268 | | Date Issued |
| Child Given Name | |
Westman | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 Aug 1889 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Andrew |
Westman | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Sweden | 37 | Father's Age |
| Mother's Given Name | Susan | Pichenburg | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 33 | 7 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | | Medical Attendant's Address |