| Certificate Number | 87 | | Date Issued |
| Child Given Name | |
Erickson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 24 Mar 1885 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Amond |
Erickson | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 41 | Father's Age |
| Mother's Given Name | Mary | Egland | Mother's Maiden Name |
| Mother's Surname | Erickson | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 31 | 6 | Number of Child This Mother |
| Medical Attendant's Name | Julia Sampson | Milford Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |