| Certificate Number | 147 | | Date Issued |
| Child Given Name | David |
Ostreim | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 May 1888 |
Randall Hamilton Co IA | Place of Birth |
| Father's Given Name | Henry |
Ostreim | Father's Surname |
| Father's Occupation | Clerk | | Father's Nationality |
| Father's Birth Place | Norway | 27 | Father's Age |
| Mother's Given Name | Anna | Kavle | Mother's Maiden Name |
| Mother's Surname | | Randall Hamilton Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 27 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Anna G. Tokheim | Story City IA | Medical Attendant's Address |