81443-188580_269

State File Number: 61

County: Piute

Child's First Name: Jack

Child's Middle Name 1: Leaver

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Page

Child's Suffix:

Sex: Male

Month of Birth (Number): 11

Day of Birth: 17

Year of Birth: 1914

Father's First Name: H

Father's Middle Name 1: R

Father's Middle Name 2:

Father's Surname: Page

Father's Title or Suffix:

Mother's First Name: Lillian

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Rappley

Is there an Amendment?: No

Document Type: Certificate of Birth