| Certificate Number | 245 | | Date Issued |
| Child Given Name | George |
Christopherson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 Sep 1888 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Peter |
Christopherson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Denmark | 31 | Father's Age |
| Mother's Given Name | Minnie | Nelson | Mother's Maiden Name |
| Mother's Surname | | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 34 | 5 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |