81443-188580_259

State File Number: 57

County: Piute

Child's First Name: Merl

Child's Middle Name 1:

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Chamberlain

Child's Suffix:

Sex: Female

Month of Birth (Number): 11

Day of Birth: 2

Year of Birth: 1914

Father's First Name: Ellis

Father's Middle Name 1: T

Father's Middle Name 2:

Father's Surname: Chamberlain

Father's Title or Suffix:

Mother's First Name: Ina

Mother's Middle Name 1: E

Mother's Middle Name 2:

Mother's Maiden Name: Frellmer

Is there an Amendment?: Yes

Document Type: Certificate of Birth