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1280148 48 Name Otts Gumma Young Age, 57. years Declaration No 18389 issued by u. A statist Distuit of Rhode below on the 3 day, of april 9.19.1917 Perition, Yol. VIII No 1806 Ondersignature the 15 day of morch 19.1920 Name aye und place of wife: nancy 25 164 Hill St. Waterary Names ages, und plaves children none Ottagunnor of holder. your New Old contifiante. Na Certificate No 1550148Received Date april 10 1920 yours

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