81443-180368-0652

State File Number: 346

County: Salt Lake

Child's First Name: Jpseph

Child's Middle Name 1: Allen

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Gallagher

Child's Suffix:

Sex: Male

Month of Birth (Number):

Day of Birth:

Year of Birth: 1912

Father's First Name: P

Father's Middle Name 1: J

Father's Middle Name 2:

Father's Surname: Gallagher

Father's Title or Suffix:

Mother's First Name: Elizabeth

Mother's Middle Name 1: Rose

Mother's Middle Name 2:

Mother's Maiden Name: Dowell

Is there an Amendment?: No