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I <br /> For the 'ear 19 %a <br /> OCCUPATION OF *, <br /> FULL NAME OF FATHER MAIDEN NAME OF MOTHER FATHER BIRTHPLACE OF BIRTHPLACE OF DATE OF <br /> OCCUPATION OF FATHER MOTHER RECORD <br /> MOTHER <br /> i <br /> ,I <br /> - k <br /> 5�... <br /> t <br /> ,4't <br /> N <br /> _ C <br /> 1i <br /> 1 <br /> FS <br />