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Form 390
1175837
37
Joseph
Aya 27 years
Declaration ofinlention. No 3576
issued by Deduce
of Waterbury
onlhe
4 day June
Perition, Vill VIII No 1752
Ondersigned on the 15
dayal
December 09919
Name. age and place ofresidence afaire
single
Names, ages and places of residence ofminor
children
none.
Societic
Files under act oh
may 9. 19.8
as amended.
funn Signature of holder.
Niw Old certifiaule. No
Certificate No. 1175837 Receibed
Date San 4
1920
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Context sent to Scholar
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