81443-180374-0354

State File Number: 3093

County: Salt Lake

Child's First Name:

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname:

Child's Suffix:

Sex: Male

Month of Birth (Number): 11

Day of Birth: 4

Year of Birth: 1912

Father's First Name: William

Father's Middle Name 1: Harris

Father's Middle Name 2:

Father's Surname: Sterling

Father's Title or Suffix:

Mother's First Name: Martha

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Thyrring

Is there an Amendment?: Yes