81443-180362-0618

State File Number: 387

County: Cache

Child's First Name: William

Child's Middle Name 1: Whitestone

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Nielsen

Child's Suffix:

Sex: Male

Month of Birth (Number): 8

Day of Birth: 20

Year of Birth: 1912

Father's First Name: William

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Nielsen

Father's Title or Suffix:

Mother's First Name: Carrie

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Whitestone

Is there an Amendment?: No