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- __— - -- For the Year 19- <br /> OCCUPATION <br /> OF <br /> FULL NAME OF FATHER MAIDEN NAME OF MOTHER FATHER BIRTHPLACE OF BIRTHPLACE OF DATE OF <br /> OCCUPATION OFFATHER MOTHER RECORD <br /> MOTHER <br /> z <br /> a� <br /> - I � <br /> — 1 <br /> f �C: <br /> ffff1 <br /> i II <br /> X, <br /> _ j <br />