81443-180368-0721

State File Number: 375

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: Male

Month of Birth (Number): 02

Day of Birth: 07

Year of Birth: 1912

Father's First Name: Alfred

Father's Middle Name 1: T

Father's Middle Name 2:

Father's Surname: Jones

Father's Title or Suffix:

Mother's First Name: Sarah

Mother's Middle Name 1: Jane

Mother's Middle Name 2:

Mother's Maiden Name: Lester

Is there an Amendment?: Yes