HomeMy WebLinkAboutBOEHM_MICHIKO_7478376No.7478376
Narne ~~~~~¥~~~~_
residing aL __~~_~P!-~~~__~~~J:.~~_~~~!._!8:~~!~~~'?~!_!'_~~~_·__
Date of birth_J.91~Ll:.~?7 Date of order of adrnission_~L~~ll_~~?_
Date certificate issued Mfl..~Qb_~_Q..._l~_Q.1 by the
__gP~Q!l-J~l:.~~.!3 Court aL_!i~_~l!~~<?I].,-_~~~_~_
Petition No.79.2_5._
Alien Registration No._~~_~~~~_~_
-------------~~---~~-----(Complete and true signature of holder)