| Certificate Number | 275 | | Date Issued |
| Child Given Name | Caroline Henrietta |
Randau | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 12 Apr 1886 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Frith |
Randau | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Germany | 55 | Father's Age |
| Mother's Given Name | Matilda | Schumann | Mother's Maiden Name |
| Mother's Surname | Randau | | Mother's Residence |
| Mother's Nationality | | Germany | Mother's Birth Place |
| Mother's Age | 33 | 10 | Number of Child This Mother |
| Medical Attendant's Name | George Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | George Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | George Stitzell | | |