| Certificate Number | 31 | | Date Issued |
| Child Given Name | Reinert Olie |
Gjerdevig | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Jul 1880 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Lars L. |
Gjerdevig | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | | Father's Age |
| Mother's Given Name | Aasa | Walker | Mother's Maiden Name |
| Mother's Surname | Gjerdevig | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | | 5 | Number of Child This Mother |
| Certificate Signer's Name | Lars L. Gjerdevig | Palestine Twp IA | Certificate Signer's Address |
| Returned by Name | Lars L. Gjerdevig | | |