| Certificate Number | 186 | | Date Issued |
| Child Given Name | Albin Julius |
Olson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 03 May 1889 |
Roland Story Co IA | Place of Birth |
| Father's Given Name | Olai O. |
Olson | Father's Surname |
| Father's Birth Place | Roland | 29 | Father's Age |
| Mother's Given Name | Johanna | Helvig | Mother's Maiden Name |
| Mother's Surname | | Roland Story Co IA | Mother's Residence |
| Mother's Nationality | | Clinton | Mother's Birth Place |
| Mother's Age | 22 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Martine Birkland | Roland IA | Medical Attendant's Address |