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--- ----- For the Year 19 Ir <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 /> V"i"U <br /> 7, <br /> „I <br /> ��U L t-t G V S<ll - '1Afl 1 P+ ���17`f Lit. CA6z � ►�C�L p c 4 <br /> I_ .J 1 <br /> ....., <br /> t <br /> j� <br /> �I <br /> L1 <br /> —J <br /> I <br /> , <br /> � y <br /> i <br /> I <br /> - r I <br /> t 1 <br /> �r4 <br /> et <br />