| Certificate Number | 413 | | Date Issued |
| Child Given Name | Susanah |
Guthrie | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 04 Sep 1882 |
| Place of Birth |
| Father's Given Name | Adam H. |
Guthrie | Father's Surname |
| Father's Occupation | Carpenter | American | Father's Nationality |
| Father's Birth Place | Ohio | 33 | Father's Age |
| Mother's Given Name | Luisa | Dakins | Mother's Maiden Name |
| Mother's Surname | Guthrie | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | Canadian | Canada | Mother's Birth Place |
| Mother's Age | 30 | 5 | Number of Child This Mother |
| Certificate Signer's Name | Susannah C. Jersey | | Certificate Signer's Address |
| Returned by Name | Susannah C. Jersey | | |