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R06EF ~
CI.ERK C~:~GUR COIlRT ~ ~
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STATE OF INDIANA f
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HARRY WILLIAM JACOBS, first beinq duly sworn deposes and
says, under oath, as follows: ~
1. That HARRY I. JACOBS was on Auqust 14, 1963, a single
adult.
2. That HARRY WILLIAM JACOBS is a blood relative of HARRY
I. JACOBS. ~
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Harry Wi iam Jaco
Sworn to and subscribed before me
this day of ~ ,1971.
N P ic ~
My Commission Expires :/~9~c~ /o, l f7~
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ac.c~rdin~ tc~ the pi:~t thereof
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1'', of the Fuhl ir_ Re~_~rds of
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