| Certificate Number | 3 | | Date Issued |
| Child Given Name | Olive Gertrude Inger |
Mikelson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Oct 1888 |
Slater Story Co IA | Place of Birth |
| Father's Given Name | Anfin |
Mikelson | Father's Surname |
| Father's Occupation | Mechanic | | Father's Nationality |
| Father's Birth Place | Norway | 48 | Father's Age |
| Mother's Given Name | Bertha K. | Anfinson | Mother's Maiden Name |
| Mother's Surname | | Ruthven Palo Alto Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 37 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.A. Rawson | Slater IA | Medical Attendant's Address |