81443-180368-0609

State File Number: 329

County: Salt Lake

Child's First Name: Howard

Child's Middle Name 1: Darrel

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Davis

Child's Suffix:

Sex: Male

Month of Birth (Number):

Day of Birth:

Year of Birth: 1912

Father's First Name: Howard

Father's Middle Name 1: A

Father's Middle Name 2:

Father's Surname: Davis

Father's Title or Suffix:

Mother's First Name: Hazel

Mother's Middle Name 1: M

Mother's Middle Name 2:

Mother's Maiden Name: Budd

Is there an Amendment?: No