| Certificate Number | 80 | | Date Issued |
| Child Given Name | |
Espeland | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 28 Dec 1888 |
Roland Story Co IA | Place of Birth |
| Father's Given Name | Nels |
Espeland | Father's Surname |
| Father's Occupation | Painter | | Father's Nationality |
| Father's Birth Place | Norway | 40 | Father's Age |
| Mother's Given Name | Martha | Jacobson | Mother's Maiden Name |
| Mother's Surname | | Roland Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 37 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Birkland | Roland IA | Medical Attendant's Address |