| Certificate Number | 11 | | Date Issued |
| Child Given Name | Arthur T. |
Vinje | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 04 Oct 1888 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | D.J. |
Vinje | Father's Surname |
| Father's Occupation | Attorney | | Father's Nationality |
| Father's Birth Place | Norway | 38 | Father's Age |
| Mother's Given Name | Helen M. | Huseboe | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 33 | 5 | Number of Child This Mother |
| Medical Attendant's Name | Ingeborg D. Dunbar | Marshall Co IA | Medical Attendant's Address |
| Returned by Name | D.J. Vinje | | |