| Certificate Number | 610 | | Date Issued |
| Child Given Name | Sylvia |
Thompson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Apr 1886 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | S.H. |
Thompson | Father's Surname |
| Father's Occupation | Cooper | | Father's Nationality |
| Father's Birth Place | Norway | 25 | Father's Age |
| Mother's Given Name | Martha | Olson | Mother's Maiden Name |
| Mother's Surname | Thompson | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 22 | | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |