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5,3g <br /> I <br /> For the Year 19 /0 <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 /> -- — - .. <br /> _ e <br /> z4uole-u Z44te, <br /> EEL <br /> _y F <br /> "a <br /> oz� o <br />