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Form 390.
1175891
41
Age, years
Name 28
Declaration ofintention. No 1210
issuedly Clerkof Deprist
Court of Costerbay
on the
31 day August
Patition, Vol. VII 161734
Entersignation, the
15
day of
December , 99999
Name, age and place of residence, of wife:
boaa. 22yrs.
74 Oakland are
Costuctory Conni
Names ages and places, of residence
children:
Jame-
Alderic Joseph Guertin
Signoture of holder.)
New
Old cerlificale. Na
Certificate No. 175891 Received
Date Fet
1920
Aldenglosed Quarter
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