HomeMy WebLinkAboutBALLANT_MARY_4477066No.4477066
Name !3)~J.,1N'lr-1-IvJl:\.Ry _
residing aL ~~~_~~}-_l __~~_~t_~}~g~'{.~_Y~l~_~L_:p_e}]A~~_
Age ?_~years.Date of order of admission_J_~p.J·-!i.'l.r.y __~~__)'_~Q~_
Date certificate issued J.anu~y_-97 _l93..9 by the
_____C_QlIll:QOfi _P~eJ~S_.Court aL ]'ia.shin~ton1_..P.enrra .._
Petition No._~?AQ _
_10142/h.!i __l3JJLE ~~-------- _
(Complete and true signature of holder>