| Certificate Number | 916 | | Date Issued |
| Child Given Name | Julia Mary |
Oleson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 27 Nov 1883 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Andrew |
Oleson | Father's Surname |
| Father's Occupation | Section Hand | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 25 | Father's Age |
| Mother's Given Name | Lizzie Jacobson | Tige | Mother's Maiden Name |
| Mother's Surname | Oleson | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 22 | 2 | Number of Child This Mother |
| Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |
| Certificate Signer's Name | B.F. Allen | Story City IA | Certificate Signer's Address |
| Returned by Name | B.F. Allen | | |