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3511
6
1987306
Name Age, John Cerulls
39 years
Declaration ofinlention. No 3931
inued by Clerkof District
Cours of Waterbury
5 day of nor. ADDRED
parth
Yol XIV No. 3367
Ondersignad. the 16 day of
A.1.19 of wife: 24
Names, ages and places, ofresidence ofminor
children maria / J -yro.
Rosie 11 yr. Liza 9 yrs Lena Egrs.
audrent Hys
704 East main Rt.
Waterbury Ct.
John Cerulls
/Signature of holder.)
Old No
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