| Certificate Number | 95 | | Date Issued |
| Child Given Name | J.G. |
Amdal | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 23 Dec 1888 |
Howard Twp Story Co IA | Place of Birth |
| Father's Given Name | Gunder |
Amdal | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 27 | Father's Age |
| Mother's Given Name | Anna | Sanvig | Mother's Maiden Name |
| Mother's Surname | | Howard Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Martin Berkland | Roland IA | Medical Attendant's Address |