81443-180368-0654

State File Number: 347

County: Salt Lake

Child's First Name: Roy

Child's Middle Name 1: Franklin

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Miller

Child's Suffix:

Sex: Male

Month of Birth (Number): 02

Day of Birth: 03

Year of Birth: 1912

Father's First Name: Roy

Father's Middle Name 1: F

Father's Middle Name 2:

Father's Surname: Miller

Father's Title or Suffix:

Mother's First Name: Cassie

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Speer

Is there an Amendment?: No