| Certificate Number | 29 | | Date Issued |
| Child Given Name | |
Erickson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 13 Dec 1887 |
Ontario Story Co IA | Place of Birth |
| Father's Given Name | Erick T. |
Erickson | Father's Surname |
| Father's Occupation | R.R. Agt | | Father's Nationality |
| Father's Birth Place | Norway | 27 | Father's Age |
| Mother's Given Name | Annie | Axelson | Mother's Maiden Name |
| Mother's Surname | | Ontario Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 24 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |