~ 18 amismm 0F
.mm
' . No i . Child’s Name. Z ' Father’s and Mother? Name.
aoéM~
I ,/
flak/(4&3 W414!” »' 7
4?: r2”, 53744474,.” ‘ ,I x [7 »~
(12%“ , 3:1}; .
5’ 4 W 07; Igllw/ , #3» / L / /
L //VI/O’D1vm/ugxyl j
X23 V [11244-4 44444, £24444,» 3%,
444 4% 4447 444444 44 44 (t (/2 , // [RC/1» r1» / C; 44/(‘/ Vgu7tm/ $109”) 8% dry/4,04,“ ‘3 '44. 6/444 1/2444 4 44444 94 9444, 94:44 64447 4444474»
/. a 90 .5510”; (flagpé/ flak 9““ /3W«7 Jodi-C44» , jgxwmx
W gag/71K fw/L/(LLQ/ . 73472240” in (Vie/24444fi; Z Kaye/5‘ thzwul
. 134'? ‘ 2441444. 477/ 4% fiéuqiu. ‘
0&9 @4444
'1 Jiwmzu'a flu? 5/flay [2474/11 Jag/41M. C/f/é-g .
Jami 4— 222 44.4444 44/47 (27W fl V «5246; M4444 M4244 W.
a 331/23. t/{é/w/ é({M “DL’ diam/41V ‘ aM//"" W
‘ ‘ \\ Father’s Trade,
VII/M _. _
Residency
J.»
ymm
C: /AW
C /. . ~— 4.4444 flint, W; 434444 [5/ (571771,
Civil State.
: . Wlteu‘Fb'orn.- . 4 ~
*géZth/v/ «4/ I? sfiofil’z- r‘y 3’0 ; a4» 4. 9/4 ._ ,5 6 a“?/€_ K’)!‘
// flea/f" rW/7
¢~W/é