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Fnrm 3HII
41
1883591
Age 50 years
Name albert Jabs
Leclaration ofinlention. No 18076
sued by Supreme
of Erie County N. y
anthe
Velition, You. XIII No 3213
7 day of June , ADD
the 15 day of
Dec.
,99193
Jame, age, and pluce of wife:
Names, ages and places, of residence ofminor
hildreg Waldamar 18 yrs
Elfreda 15-yrs. William
1yrs Helen 8 you Rinasyrs
150 Greenwood are.
materbury Come.
allect gales
(Signature of holder.)
'lu ew cerlifante. No
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