| Certificate Number | 65 | | Date Issued |
| Child Given Name | |
Bauge | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Oct 1880 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Ole N. |
Bauge | Father's Surname |
| Father's Occupation | Clerk | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 25 | Father's Age |
| Mother's Given Name | Jennie E. | Tegland | Mother's Maiden Name |
| Mother's Surname | Bauge | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merideth | Ames IA | Certificate Signer's Address |
| Returned by Name | 'mail' | | |