| Certificate Number | 164 | | Date Issued |
| Child Given Name | John B. |
Bratteboe | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 17 Jun 1890 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | Ole T. |
Bratteboe | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Norway | 25 | Father's Age |
| Mother's Given Name | Gurine | Borgen | Mother's Maiden Name |
| Mother's Surname | | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Anna G. Torkheim | Story City IA | Medical Attendant's Address |