| Child Given Name | Jonas |
Helgen | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 08 May 1879 |
Roland Story Co IA | Place of Birth |
| Father's Given Name | Ole O. |
Helgen | Father's Surname |
| Father's Occupation | Day laborer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 29 | Father's Age |
| Mother's Given Name | Ingeborg | Galta | Mother's Maiden Name |
| Mother's Surname | Helgen | Roland Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 29 | 5 | Number of Child This Mother |
| Certificate Signer's Name | Josephene E. Peterson | | Certificate Signer's Address |