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For the Year 19 9--" <br /> OCCUPATION OF <br /> FULL NAME OF FATHER MAIDEN NAME OF MOTHER FATHER BIRTHPLACE OF BIRTHPLACE OF DATE OF :J <br /> i <br /> OCCUPATION OF FATHER MOTHER RECORD <br /> MOTHER <br /> ley <br /> 1 ; <br /> /-/ D - � ! <br /> 10 <br /> i <br />-- <br /> f, <br /> J <br /> L <br /> 4 f <br /> t <br /> I <br /> X <br /> r <br /> Ell <br /> ruk <br />