81443-188583_0945

State File Number: 1342

County: Salt Lake

Child's First Name: Raymond

Child's Middle Name 1: Gaylord

Child's Middle Name 2:

Child's Middle Name 3:

Child's Surname: Gallos

Child's Suffix:

Sex: Male

Month of Birth (Number):

Day of Birth:

Year of Birth: 1914

Father's First Name: George

Father's Middle Name 1:

Father's Middle Name 2:

Father's Surname: Gallos

Father's Title or Suffix:

Mother's First Name: Emma

Mother's Middle Name 1:

Mother's Middle Name 2:

Mother's Maiden Name: Nelson

Is there an Amendment?: Yes

Document Type: Amendment or Supplement