| Certificate Number | 253 | | Date Issued |
| Child Given Name | Amos |
Landa | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 06 Feb 1884 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Ole |
Landa | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | | Father's Age |
| Mother's Given Name | Sarah | Hill | Mother's Maiden Name |
| Mother's Surname | Landa | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | | 1 | Number of Child This Mother |
| Medical Attendant's Name | D.F. Fairchild | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | D.F. Fairchild | Ames IA | Certificate Signer's Address |
| Returned by Name | D.F. Fairchild | | |