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Furm 350
Nepartificate
1507173
23
Name Axel Hjalmar
Age 42 years Goransson
Declaration ofintention. No 4124
issued by Clerkof District
Court of waterbury
4 day of February 991918
mith
You. 10 No 2260
Creder. signed the
15
day of
December 0991920
,
Name age and place of residence of wife:
widower
Names ages and places efresidence Ofminor
childron Kann Helena
Kalmar
Ocel Halmar Ground
(Signature of hotder.)
Old No.
No. 1507173 Received
Date December 15
1920
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Context sent to Scholar
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