| Certificate Number | 715 | | Date Issued |
| Child Given Name | Malinda Josephine |
Ersland | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Jul 1883 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Severt S. |
Ersland | Father's Surname |
| Father's Occupation | Laborer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 38 | Father's Age |
| Mother's Given Name | Alice Serene | Johnsen | Mother's Maiden Name |
| Mother's Surname | Ersland | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 25 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |