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ZEIZEL, KATHERINE rolxxx rg 89
/Katherine (Typewrite here Signature the name-with Jeizel here in full. surname Given names Decl given first) namestast.) XVII try 439
Common Date of order Court.) Heas of admission , at valubury 5679
Age, 29 years. Petition No.
Issued Coin. by Court (Title of of
may 8438 15th
, 1979
Declaration of Intention No.
Issued by Clerk of the
District Court of
Name, age, and 3 place of residence of wife: Dec.
on the
day of
malubury
, 19 73
X
Names, ages, and places of residence of minor children:
X
Old
No. 2933667
New Certificate No.
(Use only when new Certificate is authorized.)
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Context sent to Scholar
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