81443-180368-0697

State File Number: 364

County: Salt Lake

Child's First Name: Dorothy

Child's Middle Name 1: Avalon

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Chettle

Child's Suffix:

Sex: Female

Month of Birth (Number): 02

Day of Birth: 05

Year of Birth: 1912

Father's First Name: George

Father's Middle Name 1: Rodney

Father's Middle Name 2:

Father's Surname: Chettle

Father's Title or Suffix:

Mother's First Name: Agnes

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Marsh

Is there an Amendment?: No