HomeMy WebLinkAboutCHLUSTA_ANNA_4550288No.4550288
Name .Q.H:LU;tTA,.h.1iNA _
residing aL __J?_e__R.9YL~_~,__QQl~~_~~~_J'_E2 M~.:yJ~?n:!-~_
Age9_~years.Date of order of admission_.:r~~__?_'I,_J.~_:?~_
Date certificate issued ':!~~~_?_~1 __~_~~~by the
___~~~?E-__~~~~_s Court aL vy~~~~~_~~_~~_,__!~~z:~_~_
Petition NO·~?!.~-------v-('V /-£~~:tPI--_-uh~4-;t;;(_
(Complete and true signature of holder)