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Furm 3411 14 1883564 Age, Name graper Shilinsky 37 years Declaration ofinlention. No 2295 by of District Courts of Waterbary on the 18 day of Perition, Vill X 111 No 3118 Order. the 22 Sept. ,9.1123 Name, age and plane of vesidence of wife: Names ayes and pluces infresidence ofminor children Edmind 4yrs. 23 ward St neugatinck CT. Joseph & goseph shiliacij Signoture of holder.) Old Vew An

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