81443-180368-0676

State File Number: 356

County: Salt Lake

Child's First Name: Andrew

Child's Middle Name 1: William

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Hansen

Child's Suffix: Jr

Sex: Male

Month of Birth (Number): 02

Day of Birth: 04

Year of Birth: 1912

Father's First Name: Andrew

Father's Middle Name 1: W

Father's Middle Name 2:

Father's Surname: Hansen

Father's Title or Suffix:

Mother's First Name: Ingeborg

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name:

Is there an Amendment?: No