| Certificate Number | 596 | | Date Issued |
| Child Given Name | Ole Martin |
Nerness | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 15 Feb 1883 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Tomas O. |
Nerness | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Iowa | 24 | Father's Age |
| Mother's Given Name | Martha C. | Sheldall | Mother's Maiden Name |
| Mother's Surname | Nernes | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 25 | 1 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hayes | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes | | |