HomeMy WebLinkAboutCHITI_VICTORIA_4634753Noo 4634753
CHIT!VlCTOBIA 0Narne _
°d O t Box 44,Dunlevy,Penna.:reSl lng a - ---- -----------------_----__
Age ~~yea:rso Date of o:de:r of admission __~~_J?~~J!1..~~_?:~_"_~9J~
Date certificate issue(L~~E~~!I!~~~__?.5:L _~9_39 by the
Common Pleas Washington Fa.________________________Court at t _
Petition NOo __-J?-~l-------
v~~hdv'---~-------------------------------------------(Complete and true signature of holder)