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Firm 3911
6
Name Joaquin Cervilla
Aye.
29 years
Imlaration ofinion No 1198
insured by Superior
Court of
onlhe
2 -6 day of Oel
Perition, You.
8
No 940
26 dayal
Sep
0991918
Name age of residence of wife:
Coucella age U.resides
Tonington Come
Names of rosidence ofminor
children Raymoud nichael
bow June 1,1917 resides
Dorrington Come
feaquine berrilla / Signature of holder.)
New Old artificule Na
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Context sent to Scholar
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