| Certificate Number | 558 | | Date Issued |
| Child Given Name | |
Rasmunson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 28 May 1887 |
Iowa | Place of Birth |
| Father's Given Name | R.F. |
Rasmunson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Norway | 40 | Father's Age |
| Mother's Given Name | Rachel | Ragmuson | Mother's Maiden Name |
| Mother's Surname | Rasmunson | Howard Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |