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i <br /> RESIDENCE OCCUPATION BIRTHPLACE BIRTHPLACE DATE OF <br /> MAIDEN NAME OF MOTHER. OF PARENTS. OF FATHER. OF FATHER. OF MOTHER. RECORD. <br /> gov <br /> 201 dolz 'es <br /> AW <br /> (k-Z Qp <br /> e;,� 9", 'g, <br /> i <br /> /^) 7 <br /> D <br /> / /v�✓ l/a-t `/(/ C/����!6�� / i'Z��i�� a �_ ���2(i" [ a i /•V}}-�U/�-� • /.!'L L� a ?1 a ��a <br /> � i <br /> axe <br /> 46 <br /> 14At j g/ 0 a <br /> t <br /> Aom <br />