HomeMy WebLinkAboutCHUBIRKA_JOHN_4634973No.4634973
Name GIJQJ:?J:JJ¥A.,tlQI31L _
residing aL --Av.ella.,--P-ennsy.l¥an-ia...,.-R.--D-.--#2-.----------
Age S2...years.Date of order of admission---Jan ...-~O.,--~94-O--
Date certificate issued c!~If~~-Y __=1,9_,-__=I,9~Q by the
_C.om.rn.on_P~e_as Ccurt aL __Was.hing:t.on,_.E e.:Imal._
Petition NO----4J£7:::-1~1£--~~(Complete and true signature of holder)