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Furm 3HII
Neception
1507168
18
Name Denis anderson
Age 41 years
Declaration ofinlention. No 4147
issued by District
Court of Waterbury
onthe
14 day of February AD1918
Perition, You 10 No 2250
15
dayof
December
Name. age and plare ofresidence of wife:
62 South St. Naturary ,t.
alice 41 yrs.
Names ages and pluces infresidence of minor
children: none
Henis Andrrawn
/Signatire of holder.)
Old No
Cer tificate No. 150 7168 Received
Date December 15 1920
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Context sent to Scholar
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