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Furm 3HI
13
Age 28
Name energy max Proal
Declaration No 90684
issued by Supreme
IS day of September 991914
new york
new york County onithe
Perition, Vil. X / No 2726
Ordersignator, the
IS'
day of
march
99912
Name and place of residence, afriie:
single
Names, ages, and places of residence ofminor
children none
greery Mas /Signature Prost holder.)
of
New Old Na
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Document data
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DTO data
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Context sent to Scholar
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