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BARTUSIAK_ALEXANDRIA_4853004
A.R.R.No.4122739 No.4 853004 Narne ~~~~y~~~~,~!~~~~~~~_ residing atR _P._fJ__~-L Jr~~~_~~Ag~~~l __~~_·_ Date certificate issued __J~J;1~~r_:Y __~tL _J.~~J by the _Q~tl1~'tQRJ)l~~_~Court aL __W~~}r!·!lE~_Q~J __R.~_._ Petition No.~~Q7 _ LJ~~~~--6l~/~ (Complete and true signature of holder)