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Furm 3HI
1711380
30
Age, Name John Preslopsky
26 years
Declaration No. 5-276
Clerkel Districh
Courinf Draterbury
anthe
19 day of may A.D.1919
Yol XII Ao 2789
Order. signed , white
June 15 dayof
09912
Name age and place of residence afuile:
Jessie 25 yrs 142 Hill St
Names ages and places ifresidence ofminor
prabibing Corn.
children mike 3 5 gro. mm 2yrs.
Olga 8 mos.
142 Itill St.
naturary Com
John
Restoponky
/Signature of hotder.)
New Old cerlifiante. Na
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