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Form 3HII
1230136
Rurga. 36
Age, 42 years
Declaration, ofinlention No 2338.
issued by of Distuit
of April 09916
mitho
Perition, VII No 1662
Intersigned the 15 day of
march 9/9/1920
Name age SSE
get
Carolina 1740 Couggalia 15405 the
Duncerpo 14400- Pasquate Lupo
michelrua guns - Gooma 7400 -
Langi 5yrs- aughing 14003
Names ages, and pluces, of residence, and comministration costumer
children
/ Signature Dr Pierry of holder.)
New Old cortifiante. No
Certificate No. 1250136 Received
Date april 12 1920
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Document data
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Context sent to Scholar
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"ocrText": "Form 3HII\n1230136\nRurga. 36\nAge, 42 years\nDeclaration, ofinlention No 2338.\nissued by of Distuit\nof April 09916\nmitho\nPerition, VII No 1662\nIntersigned the 15 day of\nmarch 9/9/1920\nName age SSE\nget\nCarolina 1740 Couggalia 15405 the\nDuncerpo 14400- Pasquate Lupo\nmichelrua guns - Gooma 7400 -\nLangi 5yrs- aughing 14003\nNames ages, and pluces, of residence, and comministration costumer\nchildren\n/ Signature Dr Pierry of holder.)\nNew Old cortifiante. No\nCertificate No. 1250136 Received\nDate april 12 1920"
}