| Certificate Number | 648 | | Date Issued |
| Child Given Name | |
Snyder | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 27 May 1883 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | C.S. |
Snyder | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Ohio | 29 | Father's Age |
| Mother's Given Name | Annie E. | Wilson | Mother's Maiden Name |
| Mother's Surname | Snyder | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 26 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo. Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo. Stitzell | | |