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A.R.R.C.No.2368550 No.6072368
Name_~~Q_Q9JL_gJ~~~9 _
residing at __f:l~Q,-~~!L~q,!_§_~~~~!,.l_.9_~_!f.9~_~~.l_1?_~!_
Date certificate issued J4~r_clL2.rz.~-.1.9.44-------------by the
_CtO..mm,Ql;L~~EL~~Court at __W.ashing:ton~_Ea.._
Petition No.Q3J3~:::~~4 __b~~_
(Complete and true signature of holder)