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Form 390.
1143469
19
Name
Age,
2 40 years
Declaration No. 2557
issued by of Destruct
Country Waterling
17 day of Oct ,9.1916
Perition, Vill le No 1452
Credera signed the 1s dayof
March 99909
Name ofresidente afriie:
97 Cherry Sg Waterbay to
Edith 44 years
Names ages and places infresidence afminor
children none
Arthu Bell
Signature of holder.)
New Old Na
No 114346 9 Received
Date Manle 29
1919
Anthur Bell
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Document data
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Context sent to Scholar
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