Names of Children of Deponent

Historical Record made: ________________
Signed: Ivan A. Macfarlane, Historian
The within facts have been verified by: Rose Murphy Packar, Registrar
The within named applicant admitted: June 13, 1927
[Seal] Cornelia S. Pond, Secretary

Direct Line of Ancestry of Deponent
Christen Rasmussen
Mette K. Mortensen Rasmussen
Peter Mortensen
Lina Sanderson Mortensen

Direct Line of Ancestry of Husband of Deponent