81443-180368-0717

State File Number: 373

County: Salt Lake

Child's First Name: Virginia

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Stockseth

Child's Suffix:

Sex: Female

Month of Birth (Number): 02

Day of Birth: 06

Year of Birth: 1912

Father's First Name: R

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Stockseth

Father's Title or Suffix:

Mother's First Name: Olivie

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Steffensen

Is there an Amendment?: No