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Zontok, Mary
(Typewrite here the name-with surname first, given nameslast.)
mary Age, 40 Jan tak
(Signature here in full. Given names first.)
years. Petition No. 1928
Issued by Superior
Court
(Title of
, at
Court.)
Date of order of admission
September 16
, 1926
Declaration of Intention NOmitted under Act. Issued by Clerk of the
02
Court 01 Dep. 22, 1922.
on the
day of
, 19
Name, age, and place of residence of wife:
Names, ages, and places of residence of minor children:
Old
No. 2424636
New Certificate No.
(Use only when new Certificate is authorized.)
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- Core
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- Type
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Context sent to Scholar
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