| Child Given Name | Marion Forest |
Booher | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 10 Mar 1886 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Vitas Leander |
Booher | Father's Surname |
| Father's Occupation | Farming | | Father's Nationality |
| Father's Birth Place | Webster Co IA | 26 | Father's Age |
| Mother's Given Name | Mary Della | Andrews | Mother's Maiden Name |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 21 | | Number of Child This Mother |
| Medical Attendant's Name | Sarah Hoskin | | Medical Attendant's Address |
| Certificate Signer's Name | John Palmer Booher | Nevada IA | Certificate Signer's Address |