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Kubas, Blazej (Typewrite here the name-with surname first, given names last.) Blurry (Signature herein full Given first.) Kubas names Age, 50 years. Petition No. 2584 Issued by City (Title of Court , at NEW BRITAIN, CONN. Court.) Date of order of admission APR 16 1929 , 19 Declaration of Intention No. 3854 Issued by Clerk of the City Court of New Britain, Conn., on the 13th day of July, , 1926 Name, age, and place of residence of wife: Names, ages, and places of residence of minor children: Stella, 20 years; Stanley, 18 years; Albert, 16 years; John, 11 years; Jannie, 9 years; New Britain, Conn. Old No. 3045773 New Certificate No. (Use only when new Certificate is authorized.)