2%?

REGMEmoF 727 w 4/

. Child’s Name. ' ~ ~ Father’s and Mother’s Name. - Father’s Trade,

"I fly. % 2Z/‘fl24 %' I V2// ' % %7Vrex,c_/W// ///////2’ I’ZV' %/ a, T’ / Q /’////6 I ///<27//7/O /////”1Mfl/C/fg/ W/ , '2”! xix/4%) Zfi/

* “é” <14 7 fie.) // ”£2 2 2; 2 //€L 4/} /g2/2/// 25/562 ,4) @22/2/ //’7 Wy,>‘Z/:/// £2 flow )2?) 22;), ”2522 . , ,1 3 / ) €2/Z2u 3 / Ki;::,{,2,2,42‘ /3 / [/22 2.2‘ / [/2222 , ”23/ - 22/ Z 222 /%{27 8‘/22Z222V 4V 2/ / 22 ”222/22422;, IE /%////fl /7///7 M/ZZZI/f/QZLI /Z/72 2222222 /72/2/,22‘22/ / xiéna, ”(W -: Z2 Z/é/h/K/f’c ~25 b/i ~’7ZK ,2Z/ZA/flICZ/I cya/L/[fi/{ZUM/Zal L/é{(:/::;l,£% c247,,“ '3' 237212 44w -~

2712222222 .32 222/2% 222 Z722 ,,’2Z%2%/ / ”2.7 fl/KJLC/ 2/////2¢2/ 1223/: ,Z/ArZ/u {’22/ Zocc (”/Kfl/fi/Z

?// WKZH Z27 ”/1421 C K/fl/[Z/[Z .27221 flog; ‘27/za/2z r/J 622222 W%W /¢// fl/M/ fl/éef ' 722022222, 0 ZW/ VZZaVK an?

fly 7’LUZ fijflfll Ga Qf //Z‘/

/2/2222

.2 2/1474 Z/zc fl/Z‘VVZV/flZM/(Z/ ”22 Z //y v/Z " // £12; ¢//¢/25/,2f /2/%/ [/21/2’// /”2’ /,22722» //2V2,Z Zfl/IZZV/ 222/2222.22 % %// //2~7 ZZ/Zo/ , flu 222/:2 ,. 2.2% K24 22% ”2222/? [4222x222

/<7 4/1,..L

2/2/722K;2<:2,2é;/2/

~‘\ Z 1' ‘—

.1;—

-Res‘z’denoe.

_ .—~ .A- ,. “.—.—

WW

2 ,2“ . . 7

/ (7/222 22 22 22 2152., / , / ,,

,Z/ZZ 1,506,2////( //‘/Z-.

’////1 M// .{/(///('}'/A¢//€2

/ _ % ////z~ (fa/K £427? \. I, 2"

fg’VZ/fl/Z 2 /////r {/4 1/2 (z/

2’22222'222222 ///,, . S, 2 //// /2122 412/24,, 2, ///.‘/{/{“(1 A [/ZZZZ/zz 2., 2a; 222' //fl+// 2L"Z?/%//;01

\

, K - 1‘ 7%;4/{4/752 w W” /flzflé%/o¢c2 ;

V%2/fl% W

flM/th”

"/4242 222/W -

2." .3