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FIITIII 3911
Nepartifical 1683854
4
Age, Name John 43 Bernota
years
Declaration ofinlention. No. 3928
issued by District
Courts of Waterbury
onlhe
3 day of November, A.D.19 17
Perition, Vol. X
No 2338
Credera the
17
day of
September , ,9.1921
Name age, and place ofresidence efuile:
Jeresa 40 yrs. 21 Edward St.
waterbay Come
Names ages, Land plaves of residence, ofminor
none
John Bernota
/Signature of holder.)
New Old No
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