81443-189327_900

State File Number: 1082

County: Weber

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): 12

Day of Birth: 2

Year of Birth: 1914

Father's First Name: Henry

Father's Middle Name 1: A

Father's Middle Name 2:

Father's Surname: Jensen

Father's Title or Suffix:

Mother's First Name: Annie

Mother's Middle Name 1: A

Mother's Middle Name 2:

Mother's Maiden Name: Daley

Is there an Amendment?: Yes

Document Type: Certificate of Birth