)‘w w. ‘ Ammuy , V 7 V7- ,, _ j___ .

r - $551135

Nol CHILD’S NAME. INAME OF PARENTS. ’ DfilTlgErgF gflfisfi'l BY WHOM BAPT
. Q1 0“”) J1] Wad . . '
fafig /:j 3“2 . 7r ' ’ "
dim/mad [2px / a8. _