HomeMy WebLinkAboutBASISTA_PETE_4289170No.4289170
residing aL_Ye_qt5!:Pl.!~g,_~_~_~_
Age_59 years.Date of order of admission_.J@_e__~7.,__J..23_~_
Date certificate issued tIWJ..S!__?2 -'-_~.2.3a by the
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Petition No.__3)~39 _
---~~--~--------------------(Complete and true signature of holder)