| Certificate Number | 71 | | Date Issued |
| Child Given Name | Sanford |
Olson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Jan 1888 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Brit |
Olson | Father's Surname |
| Father's Occupation | R.R. Employee | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Julia | Furgeson | Mother's Maiden Name |
| Mother's Surname | | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |