| Certificate Number | 274 | | Date Issued |
| Child Given Name | Andrew L. |
Nelson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 05 Sep 1889 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Joseph S. |
Nelson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 36 | Father's Age |
| Mother's Given Name | Sarah | Thompson | Mother's Maiden Name |
| Mother's Surname | Nelson | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 27 | 4 | Number of Child This Mother |
| Medical Attendant's Name | A.S. Aplin | Cambridge IA | Medical Attendant's Address |