| Certificate Number | 542 | | Date Issued |
| Child Given Name | Flossie Pearl |
Goodin | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 09 May 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Edwin D. |
Goodin | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 28 | Father's Age |
| Mother's Given Name | Viola V. | Applegate | Mother's Maiden Name |
| Mother's Surname | Goodin | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |