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Form 390
1143467
17
Age 45
Name form andusturich
years
Declaration of intention. No 2471
issued by Dislud
Waterbing
onlth
16 day of Sept ,991616
Pelition, You 6 No 1458
signed the 15
day of
march 0191919
Name age und place of insidence of wife:
margaret 43 years, 432 Washington
Are Waterbing Con
Names ages and places, of residence ofminor
childron Annu 15 yrs 432
Washington are
Walebury Com
john andurkerried
(Signature of horder.)
New Old Na
No. 114346 7 Received
Date Mandi 31st
1919
L John
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