| Certificate Number | 273 | | Date Issued |
| Child Given Name | Ellen |
Fatland | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 12 Aug 1889 |
| Place of Birth |
| Father's Given Name | John H. |
Fatland | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 41 | Father's Age |
| Mother's Given Name | Sarah | Hagen | Mother's Maiden Name |
| Mother's Surname | | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 35 | 11 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |