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Form 390.
1143470
20
Name Docan Willhelen Danielson
Age
30
years
Delaration No 1073
issued by Distut
Count of Waterbay
H5 day 24 of Muccle Hebruary on the 12
Petition, You
6 No 1461
Order signed on the 15 days of
march
99999
Name. age, and place of residence afrife:
Wife Deceased
Names ages and places
children Harold Oscar, 5yrs
Torm get Coun
Oscar
/Signature of holder.)
New Na
No
Date april H.19.99
19
Oscur W. Damilson
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