81443-188580_262

State File Number: 58

County: Piute

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): 11

Day of Birth: 6

Year of Birth: 1914

Father's First Name: George

Father's Middle Name 1: Alma

Father's Middle Name 2:

Father's Surname: Bagley

Father's Title or Suffix:

Mother's First Name: Mary

Mother's Middle Name 1: Elizabeth

Mother's Middle Name 2:

Mother's Maiden Name: Wingate

Is there an Amendment?: Yes

Document Type: Certificate of Birth