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RESIDENCE OCCUPATION BIRTHPLACE BIRTHPLACE DATE OF <br /> MAIDEN NAME OF MOTHER. OF PARENTS. OF FATHER. OF FATHER. OF MOTHER. RECORD. <br /> 1:5 Ill <br /> i• HIS <br /> i <br /> , <br /> i <br /> I ; <br /> " <br /> 1 <br /> E � , <br /> �3 <br /> _ <br /> 1 <br /> j <br /> I <br /> T X. <br />