| Certificate Number | 26 | | Date Issued |
| Child Given Name | |
Hellen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Aug 1880 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Edward |
Hellen | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 27 | Father's Age |
| Mother's Given Name | Hannah | Johnson | Mother's Maiden Name |
| Mother's Surname | Hellen | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 45 | 1 | Number of Child This Mother |