| Certificate Number | 505 | | Date Issued |
| Child Given Name | Ellen |
Frowick | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Feb 1887 |
| Place of Birth |
| Father's Given Name | Erick T. |
Frowick | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 46 | Father's Age |
| Mother's Given Name | Ellen | Michalson | Mother's Maiden Name |
| Mother's Surname | Frowick | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 30 | 5 | Number of Child This Mother |
| Returned by Name | Erick Frowick | | |