81443-188580_178

State File Number REQUIRED: 29

County REQUIRED: Piute

Child's First Name: Elma

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Riggs

Child's Suffix:

Sex: Female

Month of Birth (Number): 7

Day of Birth: 13

Year of Birth: 1914

Father's First Name: Williams

Father's Middle Name 1: R

Father's Middle Name 2:

Father's Surname: Riggs

Father's Title or Suffix:

Mother's First Name: Muriel

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Snow

Is there an Amendment? REQUIRED: Yes

Document Type REQUIRED: Amendment or Supplement