81443-180374-0293

State File Number: 3069

County: Salt Lake

Child's First Name: Eleanor

Child's Middle Name 1: Jasmine

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Bell

Child's Suffix:

Sex: Female

Month of Birth (Number): 3

Day of Birth: 2

Year of Birth: 1912

Father's First Name: Alfred

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Bell

Father's Title or Suffix:

Mother's First Name: Eleanor

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Clark

Is there an Amendment?: No