HomeMy WebLinkAboutCOSTA_REGINA_5030040\,IA.'R.R.NO.2368606
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No.5030040
Narne C_QS~A~---E~~jln~---------------------------_
residing aL __RL.I>'__#.3.,__5v.rget_tS.t.own-l __P_a._
Age 5~years.Date of order of adrnission __.Ap.r1.l_2_3+-_~941_
Date certificate issued Apr.1~_2.3.,__L941 by the
Petition No ..5126__________j
\4~!t ~J!!L -:------------_f -I .(Complete a;;;h-;';;e signature of holder)