81443-180374-0268

State File Number: 3060

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): 11

Day of Birth: 01

Year of Birth: 1912

Father's First Name: John

Father's Middle Name 1: H

Father's Middle Name 2:

Father's Surname: Harrison

Father's Title or Suffix:

Mother's First Name: Violet

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Oliver

Is there an Amendment?: Yes