| Certificate Number | 271 | | Date Issued |
| Child Given Name | Eugene John |
Vanhorn | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 18 Mar 1886 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Lewis |
Vanhorn | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Wisconson | 33 | Father's Age |
| Mother's Given Name | Luie | Pool | Mother's Maiden Name |
| Mother's Surname | Vanhorn | | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | George Stitzell | Nevada IA | Medical Attendant's Address |