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Fnrm 350
Nepartifically 1507180
30
Name Seest William neilsow
Age 27 years
Damm
Declaration ofinion. No 51122
issuedly Supreme
Kings County, n.4
onlhe
Perition, You. 10.No 2270
19 day of gray ,9915
Ondersigned on the 15 day of
December 0991920
Name, age and place of residence of wife:
agnes 27 yrs.
22 wildword are Walutry
Colu
Names ages, sand places of residence of minor
children
none
Sees Mallian Neilsen Damn
Signatire of holder.)
A Old No
Certificate No. No 7180 Received
Date December 15 1970
5
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