| Certificate Number | 380 | | Date Issued |
| Child Given Name | |
Oleson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 09 Sep 1886 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Andrew |
Oleson | Father's Surname |
| Father's Occupation | Section Boss | | Father's Nationality |
| Father's Birth Place | Norway | 29 | Father's Age |
| Mother's Given Name | Lizzie J. | Craig | Mother's Maiden Name |
| Mother's Surname | Oleson | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 25 | 3 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merideth | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merideth | | |