| Certificate Number | 58 | | Date Issued |
| Child Given Name | Edith |
Shugart | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 20 Dec 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | John A. |
Shugart | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 33 | Father's Age |
| Mother's Given Name | Dora | Baker | Mother's Maiden Name |
| Mother's Surname | Shugart | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 4 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |