81443-180368-0605

State File Number: 328

County: Salt Lake

Child's First Name: Joseph

Child's Middle Name 1: Stanford

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Shelly

Child's Suffix:

Sex: Male

Month of Birth (Number):

Day of Birth:

Year of Birth: 1912

Father's First Name: Ernest

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Shelly

Father's Title or Suffix:

Mother's First Name: Mary

Mother's Middle Name 1: Elizabeth

Mother's Middle Name 2:

Mother's Maiden Name: Anderson

Is there an Amendment?: No