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Form 350
Naportificate
1645122
22
Name anno Stricbe
Age 43 years
Declaration of intention. No 1540
issued by District
Count of Waterbary
only
Perition, 16 You. of 6 August No AD1913 1241
Ondersigned the 16 dayal
June
991921
,
Name agenand place of wife:
martha up noyers 173 Bradleyst
report Come.
Names, ages, and plates of residence of minor
children Hillegard 17 yrs.
Felise 16 yrs Elly 13yrs.
173 Bradley Lt
Bird geport, Com
Chrosetting
/ Signature of houder.)
New Oll corlificale. Na
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