81443-180368-0669

State File Number: 354

County: Salt Lake

Child's First Name:

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname:

Child's Suffix:

Sex: Female

Month of Birth (Number): 02

Day of Birth: 04

Year of Birth: 1912

Father's First Name: Fred

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Gygi

Father's Title or Suffix:

Mother's First Name: Louise

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Furer

Is there an Amendment?: No