81443-180374-0306

State File Number: 3073

County: Salt Lake

Child's First Name: Mary

Child's Middle Name 1: Aileen

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Wise

Child's Suffix:

Sex: Female

Month of Birth (Number): 11

Day of Birth: 2

Year of Birth: 1912

Father's First Name: John

Father's Middle Name 1: H

Father's Middle Name 2:

Father's Surname: Wise

Father's Title or Suffix:

Mother's First Name: Alice

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Ward

Is there an Amendment?: Yes