81443-180374-0286

State File Number: 3066

County: Salt Lake

Child's First Name: Jennie

Child's Middle Name 1: Leone

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Mantle

Child's Suffix:

Sex: Choose Sex

Month of Birth (Number): 11

Day of Birth: 02

Year of Birth: 1912

Father's First Name: Louis

Father's Middle Name 1: J

Father's Middle Name 2:

Father's Surname: Mantle

Father's Title or Suffix:

Mother's First Name: Lillie

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: McAlister

Is there an Amendment?: Yes