81443-180374-0317

State File Number: 3077

County: Salt Lake

Child's First Name: Mack

Child's Middle Name 1: Lloyd

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Wilson

Child's Suffix:

Sex: Male

Month of Birth (Number): 11

Day of Birth: 3

Year of Birth: 1912

Father's First Name: Loran

Father's Middle Name 1: Alra

Father's Middle Name 2:

Father's Surname: Wilson

Father's Title or Suffix:

Mother's First Name: Mary

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Scott

Is there an Amendment?: Yes