| Child Given Name | Anna Karina |
Sheldahl | Child Surname |
| Child Sex | |
W | Child Race |
| Date of Birth | 14 Aug 1883 |
Sheldahl Story Co IA | Place of Birth |
| Father's Given Name | Osmond |
Sheldahl | Father's Surname |
| Father's Occupation | Pastor | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 62 | Father's Age |
| Mother's Given Name | Anna | Tweedt | Mother's Maiden Name |
| Mother's Surname | | Sheldahl Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 36 | | Number of Child This Mother |
| Certificate Signer's Name | A.L., Mrs. Dobbe | | Certificate Signer's Address |