| Certificate Number | 250 | | Date Issued |
| Child Given Name | Eveline |
Osborn | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 16 Aug 1890 |
I.A.C. | Place of Birth |
| Father's Given Name | Herbert |
Osborn | Father's Surname |
| Father's Occupation | Prof Zoology | | Father's Nationality |
| Father's Birth Place | Wisconson | 34 | Father's Age |
| Mother's Given Name | Dorathay | Sayles | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 37 | 3 | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |