| Certificate Number | 603 | | Date Issued |
| Child Given Name | Eugene |
McLain | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 04 Aug 1887 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | John |
McLain | Father's Surname |
| Father's Occupation | Barber | | Father's Nationality |
| Father's Birth Place | Illinois | 29 | Father's Age |
| Mother's Given Name | | Page | Mother's Maiden Name |
| Mother's Surname | | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 31 | | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |