ENTRY FORM(FOR INDIVIDUAL ORDINANCES)

- Sta ke ai' Mission

Bellevue WashingtonAddress 16611 S. E. 8 th Ward Examin r

C43 'Ward Examiner

for ~ Baptism ~ Endowment Sealing

Name {Per SQn to receive nofificoti cn]

Bertha S era un

Bellevue, WA 98008 Please reserve q,l!.alifyinil names in thJ family file at theSeot+le

Temple

Race

6 Birthplace (parish or town, covnty, ,tote or counlry)Perez Mex

7 Birth date (day, month, year)abt 1825

8 Christening place (pcr:,h, county, state Of country)

Augualeguas, Nuevo Leon, Mexi co9 Christening date (day, month, year)

e

12 Death or burial date of 3 above (cluy, month, yeer)10 Father's given name (s) 11 Father's surname (s)

Luciano Garza

Father's title or occupation

3 16 LOS baptism date

Father's residencePere LG

18 Date sealed to parents

13 Mother's given name (s) 14 Mother's surname (s)

19

'. 8 Christening place (perish, covnry, stale or country)

6 Birthplace (parish or town, county, stote or country)\II.. V\

7 Birth date (cley, month, year)

abt 1850

Father's residence Father's title or occupation

9 Christening date (day, month, vecr )

14

Gonzales15 Your relationship t 16 LOS baptism date

s-g -g -do u (sea led)

,10 Father's given name (s) 11 Father's surname (s) 12 Death or burial date of 3 above (day, month, ve cr )

13 Mother's given name (s)

Fernina17 Endowment date 18 Date sealed to parents

19

Antonio Vicente Ferrer Salinas

Father's residence Father's title or occupation

9 Christening date (day, month, year)

6 Birthplace (parish or rown, county, stale country)r_'. II\. V\.

7 Birth date (day, month, year)

abt 17928 Christening place (pm,sh, county, or country)

Ma dalena14 Mother's surname (s) 16 LDS baptism date

10 Father's given name (s)

Juoquin11 Father's surname (s)

Salinas12 Death or burial date of 3 above (doy, month, year)

13 Mother's given name (s) 15 Your relationship to 3

Date sealed to parentsPe na

19 Source of informationsame as above FDD

MDD

I was sealed to them in the Logan Temple 18 Feb. 1925·

PFGS009-5 1/73 SOOM PRINTED IN USA BY PUBLISHERS PRESS (FDD-father's death date; MDD-mother's death date)