81443-180362-0570

State File Number: 368

County: Cache

Child's First Name: Karl

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Groll

Child's Suffix:

Sex: Male

Month of Birth (Number): 8

Day of Birth: 11

Year of Birth: 1912

Father's First Name: John

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Groll

Father's Title or Suffix:

Mother's First Name: Mary

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Bucher

Is there an Amendment?: No