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A.R.R.NO.1491944
No.5030108
Narne ~JlC~O~-~~~1-t~----------------------------
residing at-.95.B -.EarJeStr.e.e.t-,--Ca tif-cI'n1&-,.-~a-.-----_-_
Age ~years.Date of order of adrnission--..June--23,--l941---
Date certificate issued -JUl18--23-,.--194-1-by the
_C.ommon _P..le.as Court aL ---Ylas.h.1ng-t on,--Pa.._
Petition No._-539.3._
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4.:/-L -~~2omplete and true signature of holder)