81443-180362-0653

State File Number: 402

County: Cache

Child's First Name: Quantar

Child's Middle Name 1: T

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Maxwell

Child's Suffix:

Sex: Male

Month of Birth (Number): 8

Day of Birth: 31

Year of Birth: 1912

Father's First Name: Joseph

Father's Middle Name 1: R

Father's Middle Name 2:

Father's Surname: Maxwell

Father's Title or Suffix:

Mother's First Name: Ida

Mother's Middle Name 1: Marie

Mother's Middle Name 2:

Mother's Maiden Name: Thoresen

Is there an Amendment?: No