81443-181549_0752

State File Number: 56

County: Rich

Child's First Name: Enice

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Smith

Child's Suffix:

Sex: Female

Month of Birth (Number): 11

Day of Birth: 11

Year of Birth: 1913

Father's First Name: Marion

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Smith

Father's Title or Suffix:

Mother's First Name: Be

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Kennedy

Is there an Amendment?: Yes

Document Type: Amendment or Supplement