81443-189326_0116

State File Number: 339

County: Choose County

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: Female

Month of Birth (Number): 4

Day of Birth: 13

Year of Birth: 1914

Father's First Name: William

Father's Middle Name 1: Z

Father's Middle Name 2:

Father's Surname: Shurtliff

Father's Title or Suffix:

Mother's First Name: Ida

Mother's Middle Name 1:

Mother's Middle Name 2: Latham

Mother's Maiden Name:

Is there an Amendment?: No

Document Type: Certificate of Birth