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DeBerardinis, Rosa Wilhemina
Vol*XIV rg12 rg 12
Rosa Wilhomina (Typewrite (Signature here the name-with here in full. surname Given De first, given first.) nameslast) Berardinis
names
Common Age, 29 Pleas , at
years.
Petition No.
Court.)
Date of order of admission
gavone 17
waterbury 5007
Issued Come by Count (Title of of
, 1928
Declaration of Intention No.
Issued by Clerk of the
Court of
on the
day of
, 19
Name, age, and place of residence of wife:
X
Names, ages, and places of residence of minor children:
X
No. 2650225
Old
New Certificate No.
(Use only when new Certificate is authorized.)
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Context sent to Scholar
Document identity
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