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Form 390
1143479
29
Name
Age
32 years
Declaration ofinlention. No 1560
issued by District
Court of Waterbany
on the
20 day of sept
,9913
,
Perition, Yoil. 6 No 1471
Ondersignation, the 15 day of
march 0991919
Name, age and place ofresidente of wife:
none
Names ages and places effesidence of minor
children
you e
Wanate antonio strolls.
(Signative of holder.)
Oll
Date april 3
No 1443479 Received
Donato antonio Sthella 1219
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