81443-180374-0282

State File Number: 3065

County: Salt Lake

Child's First Name: Willard

Child's Middle Name 1: Clemens

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Moebest

Child's Suffix:

Sex: Male

Month of Birth (Number): 11

Day of Birth: 01

Year of Birth: 1912

Father's First Name: Clemens

Father's Middle Name 1: Harmon

Father's Middle Name 2:

Father's Surname: Moebest

Father's Title or Suffix:

Mother's First Name: Agnes

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Neiborg

Is there an Amendment?: No