| Certificate Number | 559 | | Date Issued |
| Child Given Name | Maggie N. |
Oliverson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Feb 1883 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Tom |
Oliverson | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 48 | Father's Age |
| Mother's Given Name | Mary | Toreson | Mother's Maiden Name |
| Mother's Surname | Oliverson | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 39 | 8 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M Brown | | |