| Certificate Number | 645 | | Date Issued |
| Child Given Name | |
Halverson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 15 Apr 1883 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | John |
Halverson | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 45 | Father's Age |
| Mother's Given Name | Marguite | Martinson | Mother's Maiden Name |
| Mother's Surname | Halverson | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 42 | 11 | Number of Child This Mother |
| Medical Attendant's Name | Jno I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | Jno I. Hostetter | | |