| Certificate Number | 924 | | Date Issued |
| Child Given Name | |
Goodin | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Apr 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Edward D. |
Goodin | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Viola V. | Applegate | Mother's Maiden Name |
| Mother's Surname | Goodin | | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 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 | | |