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CICCI_ANTONIO_3925690
No.3 925 690 Name gJ_~~_~,~_~9}'!~~.---------------------------------- residing aL_f _9__~~~__~_~~~_~~_~!~~~_1?___~~_..._ Age_~g years..Date of order of admission_September 23,193----------------------- Date certificate issued 9J~P_~E?lIl t>~X _J~9J __:l:~?i_~by the __~9_~~~__~~_~~~Court at Washington,Fa.------------------------------------ -----~~-----~/(Complete and true signature of hoW;;)- - - - - - - - - - - - - -