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I <br /> For the Year 19 <br /> OCCUPATION OF ., <br /> FULL NAME OF FATHF-R MAIDEN NAME OF MOTHER <br /> FATHER BIRTHPLACE OF BIRTHPLACE OF DATE OF <br /> OCCUPATION OF FATHER MOTHER RECORD <br /> --- MOTHER <br /> 001 <br /> -Ae� 00'0 <br /> IN <br /> #ZIA 6m <br /> _ 1 <br /> -- ` <br /> `1Y1 <br /> mP5 \1 H v'►"' 23 <br /> Lak - v nine S MA <br /> A W6)cm <br /> Fm <br /> vAjA&Aj00j — --- <br />