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Form 390.
1143500
50
Age, 42
Name george Dash
years
Declaration No 5689
issued by Common Please
Court of Schnyskiee County Pa
on the
19 day of
Prittion, You 6 No 1482
Ondersignadure the
16
Name, age and plan of residence of wife:
June
Single
Names ages and places infresidence of minor
children none
George / Dash
Signature of holder.)
bld certificale. No
'Certificate I.o. 11435.00 Recetved
Date July 7
1919
George Dash
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