HomeMy WebLinkAboutBORKOWSKI_MARY_3925623No.3925623
Name __J29Jn\:.Q-~~15I '-_.M~RY _
Age __38 years.Date of order of admission----J-anuar.:y-.J..3-,--Lg3
Date certificate issued -<1anunr y--_1_3.-1-_lR:3.6 by the
Petition No.27BL _
--~~--~~~~-----------------{/(Complete and true signature of holder)