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Form 390.
1175819
19
Name michael Callins
Age, 5'3 years
Declaration ofinlention. No 3275
issued by of District
Court of evalubury
onlth
/ day of may
Perition, You. 7 No 1640
Ondersignation, the 5
day of
September
19.1919
Name, age, and place of residence, afriie:
margaret 43 yrs. 6 / Southleests
waterbury
Names ages and places, of residence ofminor
children Thomas. 20 yrs.
Christopher. 17 yrs.
John liyrs.
611 South Vein tt
waterbury Comu.
Michael Celems
Signature of holder.)
New Old certifiante. Na
Certificate No 1175819 Received
Date
Sept. 18 1919
mentual colime
mrs Collins
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"ocrText": "Form 390.\n1175819\n19\nName michael Callins\nAge, 5'3 years\nDeclaration ofinlention. No 3275\nissued by of District\nCourt of evalubury\nonlth\n/ day of may\nPerition, You. 7 No 1640\nOndersignation, the 5\nday of\nSeptember\n19.1919\nName, age, and place of residence, afriie:\nmargaret 43 yrs. 6 / Southleests\nwaterbury\nNames ages and places, of residence ofminor\nchildren Thomas. 20 yrs.\nChristopher. 17 yrs.\nJohn liyrs.\n611 South Vein tt\nwaterbury Comu.\nMichael Celems\nSignature of holder.)\nNew Old certifiante. Na\nCertificate No 1175819 Received\nDate\nSept. 18 1919\nmentual colime\nmrs Collins"
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