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Galvatore (Typewring Chieta the name-with here surname first, given names last. ) Signature here in full. Given names first.) Age, 26 years. Petition No. 1121 Issued by Superior (Title of , at Middletown, Conn. Court.) Date of order of admission October 1, , 1926 Declaration of Intention No. 1407 Issued by Clerk of the Superior Court of Middlesex County, Conn. on the 5th day of November , 19 20 Name, age, and place of residence of wife: Marion age 23, Middletown, Conn. Names, ages, and places of residence of minor children: Paul M. age one year, Middletown, Conn. Old No. 2425035 New Certificate No. (Use only when new Certificate is authorized.)