| Certificate Number | 930 | | Date Issued |
| Child Given Name | Nels Steward |
Bauge | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 01 Mar 1884 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | T.M. |
Baug | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 37 | Father's Age |
| Mother's Given Name | Martha | Nerms | Mother's Maiden Name |
| Mother's Surname | Baug | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Iowa | Mother's Birth Place |
| Mother's Age | 27 | 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 | | |