81443-180368-0674

State File Number: 355

County: Salt Lake

Child's First Name: John

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Stanuga

Child's Suffix:

Sex: Male

Month of Birth (Number):

Day of Birth:

Year of Birth: 1912

Father's First Name: Thomas

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Stanuga

Father's Title or Suffix:

Mother's First Name: Anna

Mother's Middle Name 1: Margaret

Mother's Middle Name 2:

Mother's Maiden Name: Vlasich

Is there an Amendment?: No