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Furm 3HII 1360385 35 Name alexander Inyer, Age, 41. years Declaration No289 issuedly of Disluit Walebuly on the 2 day of me 9.19.19 Perition, YOU No 1971, Untersigned.on the 15 day of morch 0991020 Name, age and place of wife: Faancis 3r. 57 Ins St, (valuture Names ages and places of rosidence of minor children louinnd 11 yrs. mma. 10 yrs. 5ysnsts, alexander Inyers (signature of New Old cerlifionte. Na Certificate No. Date Ohril 16 19211

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