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Lurge Dr (Typewrite (Signature here the name-with here in full. surname Given firs names first.) rg 440
DiLENA, LUIGI rolxxvill Pg68
Age, 40 years. Petition No. 5358
Issued by Court (Title of of
Common Date of order Court.) Pleas of admission , at materbury you Comu.
, 1929
Declaration of Intention No.
District
Court of waterbury 6939
Issued by Clerk of the
Name, on the age, and 30 place of residence day of of wife : July x
, 19 H H
your Names, ages, and places of residence Rigoletta Querica of minor children: 6yrs. amanda13ys Hyes.
No.
2040 2933590 Main Old New St. Certificate Inability No. (Use only when new Certificate Comu. is authorized.)
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