81443-188580_286

State File Number: 68

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: Male

Month of Birth (Number): 12

Day of Birth: 25

Year of Birth: 1914

Father's First Name:

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname:

Father's Title or Suffix:

Mother's First Name: Violet

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Howes

Is there an Amendment?: No

Document Type: Certificate of Birth