| Certificate Number | 144 | | Date Issued |
| Child Given Name | Nettie M. |
Borgen | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 May 1890 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | M.L. |
Borgen | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Norway | 45 | Father's Age |
| Mother's Given Name | Julia | Olson | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 35 | 8 | Number of Child This Mother |
| Medical Attendant's Name | Gurhard Olson | Nevada IA | Medical Attendant's Address |