| Certificate Number | 805 | | Date Issued |
| Child Given Name | |
Hawthorn | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Oct 1883 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | James |
Hawthorn Jr. | Father's Surname |
| Father's Occupation | Merchant | American | Father's Nationality |
| Father's Birth Place | Nevada Story Co IA | 25 | Father's Age |
| Mother's Given Name | Kittie L. | Coe | Mother's Maiden Name |
| Mother's Surname | Hawthorn | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Henry Co IL | Mother's Birth Place |
| Mother's Age | 21 | 3 | Number of Child This Mother |