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3HII 10 Age, Name Robert 21 James Jurner years Declaration No 4365 isseed by District Courself wateriary onthe Perition, Yol. XII No 2777 20 day of July 19.1918 , the 15 days of march 09912 Name, age and place of residence unwife: single Names ages, and pluces, ofresidence of minor children none Robert James Lurner /Signature of holder.) New Old certificate. Na

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Document data

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