81443-188585_767
Facsimile
Transcription
Status: Complete
State File Number REQUIRED: 2040
County REQUIRED: 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: Male
Month of Birth (Number): 6
Day of Birth: 29
Year of Birth: 1914
Father's First Name: Edward
Father's Middle Name 1: David
Father's Middle Name 2:
Father's Surname: Wallin
Father's Title or Suffix:
Mother's First Name: Linnea
Mother's Middle Name 1: Elizabeth
Mother's Middle Name 2:
Mother's Maiden Name: Peterson
Is there an Amendment? REQUIRED: Yes
Document Type REQUIRED: Certificate
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