| Certificate Number | 627 | | Date Issued |
| Child Given Name | George |
Osmundson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 12 Apr 1883 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Henry J. |
Osmundson | Father's Surname |
| Father's Occupation | | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 29 | Father's Age |
| Mother's Given Name | Betsy | Peterson | Mother's Maiden Name |
| Mother's Surname | Osmundson | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Wisconson | Mother's Birth Place |
| Mother's Age | 25 | 3 | Number of Child This Mother |