81443-180368-0639

State File Number: 341

County: Salt Lake

Child's First Name: LeRoy

Child's Middle Name 1: Franklin

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Greensides

Child's Suffix:

Sex: Male

Month of Birth (Number): 02

Day of Birth: 02

Year of Birth: 1912

Father's First Name: Henry

Father's Middle Name 1: H

Father's Middle Name 2:

Father's Surname: Greensides

Father's Title or Suffix:

Mother's First Name: Jane

Mother's Middle Name 1: A

Mother's Middle Name 2:

Mother's Maiden Name: Brown

Is there an Amendment?: No