81443-180362-0627

State File Number: 392

County: Cache

Child's First Name: Alvin

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Lott

Child's Suffix:

Sex: Male

Month of Birth (Number): 8

Day of Birth: 24

Year of Birth: 1912

Father's First Name: Cornelius

Father's Middle Name 1: B

Father's Middle Name 2:

Father's Surname: Lott

Father's Title or Suffix:

Mother's First Name: Jane

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Clarks

Is there an Amendment?: No