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Furm 3911
13
Nepactificate
1987313
Name, Age
27
your
Declaration ofinlention. No 56 99
issued by Clerkof Destrict
Court of Waterbury
onthe
15 day of 20r. 10.11.1919
Perition, XIV No 3381
Order. signation, the 16 daysof
Names
June and of residence of wife:
A919 24
Names ages and planes, of residence of minor
children
Adam /Signature
January
of holder.)
New Old cortificate. Na
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Document data
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DTO data
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Context sent to Scholar
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