| Certificate Number | 345 | | Date Issued |
| Child Given Name | Oley Jr. |
Nelson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 26 Sep 1889 |
Sheldahl Story Co IA | Place of Birth |
| Father's Given Name | Oley |
Nelson | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Wisconson | 44 | Father's Age |
| Mother's Given Name | Lizzie | Ersland | Mother's Maiden Name |
| Mother's Surname | | Slater Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 39 | 9 | Number of Child This Mother |
| Medical Attendant's Name | E.A. Rawson | Slater IA | Medical Attendant's Address |