| Certificate Number | 10 | | Date Issued |
| Child Given Name | |
Mahorter | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 20 Oct 1889 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Andrew |
Mahorter | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 40 | Father's Age |
| Mother's Given Name | Teressa | Santry | Mother's Maiden Name |
| Mother's Surname | | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 36 | 4 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlin | Nevada IA | Medical Attendant's Address |