81443-180374-0287

State File Number: 3067

County: Salt Lake

Child's First Name: Edith

Child's Middle Name 1: Mary

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Hansen

Child's Suffix:

Sex: Female

Month of Birth (Number): 11

Day of Birth: 2

Year of Birth: 1912

Father's First Name: Andrew

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Hansen

Father's Title or Suffix: Jr

Mother's First Name: Emma

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Hadford

Is there an Amendment?: No