81443-188889_112

State File Number: 42

County: Summit

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): 2

Day of Birth: 24

Year of Birth: 1914

Father's First Name: Morgan

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Lewis

Father's Title or Suffix:

Mother's First Name: Zenith

Mother's Middle Name 1: Ethelyn

Mother's Middle Name 2:

Mother's Maiden Name: Mitchell

Is there an Amendment?: Yes

Document Type: Certificate of Birth