| Certificate Number | 14 | | Date Issued |
| Child Given Name | Martin Anfin |
Skien | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Oct 1889 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | John T. |
Skien | Father's Surname |
| Father's Occupation | Carpenter | | Father's Nationality |
| Father's Birth Place | Norway | 30 | Father's Age |
| Mother's Given Name | Celia | Anfinson | Mother's Maiden Name |
| Mother's Surname | | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 29 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Anna G. Tokheim | Story City IA | Medical Attendant's Address |