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MAIDEN NAME OF MOTHER RESIDENCE OF OCCUPATION OF BIItTHPLACE OF BIRTHPLACE OF DATE OF <br /> PARENTS FATHER FATHER MOTHER RECORD <br /> Pli X6 <br /> 6 <br /> •�G t.%� 4-4 e , 'rL"�/SGC/ t //�" '�// ]/�� ��• r. <br /> -- <br /> jr <br /> 76 <br /> ........... -------- <br /> i <br /> I <br /> i <br /> ♦y <br /> } <br /> f <br /> s <br /> 3 <br /> 11 <br /> 1 <br /> Y <br /> ' I <br /> I � i <br /> y F E <br /> 1 <br /> i f, <br />