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Form 390.
Nepartifugate 1175870
20
Name nathan Pooff
Age, 40
years
Declaration of intention. No 1547
issued by of Distuit
Calubury
onthe
30 day of
Palition, You. VII No 1693
Order. signed on, the 15 dayal
December
99999
Name age and place of residence
Pauline 38. Jilto
Main St. Walebumy Come.
Names ages and places infresidence of minor
none
nathan Rooff
/Signature of holder.)
New Certificate Old cerlificate. K 1175870 Received
Date
Jan 27
1920
nathan Beff
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Document data
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- Core
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Context sent to Scholar
Document identity
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