81443-180360-0026

State File Number: 6

County: Beaver

Child's First Name: Theo

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Davis

Child's Suffix:

Sex: Male

Month of Birth: January

Day of Birth: 14

Year of Birth: 1912

Father's First Name: Leon

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Davis

Father's Title or Suffix:

Mother's First Name: Idona

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Eyre

Is there an Amendment?: Yes