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Firm 3HII
49
1883599
Age, Name John Lavallee
years
Declaration ofinlention. No 4160
suedly District
of Waterbury
23 day of Feb 18
Verition, Yol. XIII No. 3231
indersigned anthe 15 day of
Dec. A.1.1923
Jame: age eand place ofrendence of wife:
Names, ages, and places, of residence, ofminor
hildren: Rita 10 syro. yoette
5 grs
179 So. Elm St.
naturation Ct.
I opm Carallie
(Signature, of holder.)
No
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