81443-180374-0265

State File Number: 3059

County: Salt Lake

Child's First Name: Robert

Child's Middle Name 1: George

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Smith

Child's Suffix:

Sex: Male

Month of Birth (Number): 11

Day of Birth: 01

Year of Birth: 1912

Father's First Name: George

Father's Middle Name 1: A

Father's Middle Name 2:

Father's Surname: Smith

Father's Title or Suffix:

Mother's First Name: Myrtle

Mother's Middle Name 1: M

Mother's Middle Name 2:

Mother's Maiden Name: McKnight

Is there an Amendment?: Yes