| Child Given Name | Annie Margrete |
Rasmusson | Child Surname |
| Child Sex | |
W | Child Race |
| Date of Birth | 17 May 1888 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Christ G. |
Rasmussen | Father's Surname |
| Father's Occupation | Farming | Dane | Father's Nationality |
| Father's Birth Place | Denmark | 37 | Father's Age |
| Mother's Given Name | Mary | Olson | Mother's Maiden Name |
| Mother's Surname | | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Dane | Denmark | Mother's Birth Place |
| Mother's Age | 28 | | Number of Child This Mother |
| Certificate Signer's Name | Walter Rasmusson | | Certificate Signer's Address |