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3HII
41
Nepartifically
1987341
Name albert Forest
Age, 27 years
Declaration ofintention. No. 6821
District
Waterbary
Patition, Yol. XIV A 346 : 3
21 day of may
Ondersigned che 16 day of
June , A919
24
Name, cage and place of wife:
Names, ages, and places, of residence, ofminor
2yrs.
5 mos
239 River St.
naturating Come
albert Forest
/Signature of holder.)
New Old certificale. Na
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