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Form 390.
1143474
24
Name Simon Machulolics
Age 43 years
Declaration ofintention. No 1428
issuedly District
Waterbury
ondhe
22 day of mand
Patition, You 6 No 1465
the is day of
march 19.1919
Name. age und plure of residence, of
Ma gaie, 38 years, 110 Congress
are Watering Com
Names ages and places, of residence ofminor
children: millie, 10 yrs, alice 8 yrs
Bronie 4 years, Edmund I yr
110 Con grees are w atulry
Com
Simon Machubin
/Signature of holder.)
New Old cerlifiante. No
Certificate No. 164474 Received
Date March 29 1969
Sinou Merchddris
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"ocrText": "Form 390.\n1143474\n24\nName Simon Machulolics\nAge 43 years\nDeclaration ofintention. No 1428\nissuedly District\nWaterbury\nondhe\n22 day of mand\nPatition, You 6 No 1465\nthe is day of\nmarch 19.1919\nName. age und plure of residence, of\nMa gaie, 38 years, 110 Congress\nare Watering Com\nNames ages and places, of residence ofminor\nchildren: millie, 10 yrs, alice 8 yrs\nBronie 4 years, Edmund I yr\n110 Con grees are w atulry\nCom\nSimon Machubin\n/Signature of holder.)\nNew Old cerlifiante. No\nCertificate No. 164474 Received\nDate March 29 1969\nSinou Merchddris"
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