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HomeMy WebLinkAbout0371 _ , 10/ f 3~o~oi~? I , . ~e.~°° DEAT~ : ~EG~~TRATiON ~~RM - 1. DFJ1 !N THE DISTRICT OF _~~~~~i ~ 2. P~RISH ~ ' . ~~~y'~~L~~~~a~3 3. NO ~ - 3169 0o eft nm~ ~ , t~a ~ ~j pw~.:o~ ~ir~ ~ ~ ; u° ~n~ o~ n~~ . ~ ~ ~ ~2 R~~. ./'b,~~~~c~ ~i~ : . . . s•.~. . . . . . ~~i(JK~G~I~. . . . . . . . . . " ~;~.oa~~.~ ~ io)'~.~:'.'.~..i .~r~...ct~s.ur,r...................... P•ar~cma~a or Dscs?ssn 13. C~we o~ Dar?~ I ' ~ ~ I (Ymmsdi~te Cau~s) us S. Date of ~estL . . . . . ~~CIi:!~!~!F:{!. . . . ~-c,c~~,,~c% . . . P. . . . . . . . . . . c.r~~:~.~r. . . . . , ~';~.r~ ~..~v . . . . . . . . ; e. ~u Pl.me. l~~!f.~t< . . . . . . , aa. eo . ~ ~~t2~~'•'P?~: si ,'L,~?t:Cf ~t . . ~ ~ i~: a.~ . ~~6. to ; 7. Se:.!~,.~~'.~;tGP!s. Conditid~u:l~!.......•.. (e).-• a Y. Aas ~y/.'.~n........ montlu. ......d~ri II (Contribntory)... . . ? 10. Occ~ep~tion or osllia~: f~~'~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ i ; ~ • ~ . . . . . . . . . . . . . . . . . . . . _ . . . . . • • - • • - - . . . 14. CertiSed b~.t~~Zs~? . . . lF.:. ~~!3nGl~~. . . , 11. &rtl~plaop.a~FLf .^~2G~?'a'~Q ~ y ~ . . /~!.!~['if,. . . . s!~ .Y r!'~. . r . . . . . . . . + . ~ ~ , ~ . ~ Itf!'OR1t~NT ~n'. i l ~ ~ ~ . a ia. xs~~.~ias v. a> ~a~ ...1....4c~r~,~~.us~. « ..eG~~ . ~ , ~ ~~lf~ . . (b) Town w~Villass. . . . . . . . . . . . . . 16.~Qu li~ca~twuv. G'Y~L'u~. ~r ~.v-. -G~s~-~a~ ~ :3 • ~~`-•g. • 1`' , (e) Psri~L. ~ u7. . " i~ ,-f~t~LU;~. cl~ ~j~; • _ V~ . . . . . . sipsafwrs oj t+1/anw 1W. - ' 6~ . Iisomn.r: Csx„na~~; 1 , : ,j ~ ~ i 18. f6aned in my praeenoe br the ~sid inlormant ; ro) (or) ' ......i......... 4 1~. Wi ' i ~o. .........~..d . ~ ~~t . ~ i. _ _ ~ ~ 21~ 9isned....... . OJ!'i~+~F~v.~ - ~ R~Y++1?~' ' _ ~ 1 rn~-~.~w~s..~N~erQ~x~~ ? s ~ ~ 37~ ' _ S- ~ f ~ ~ ' BOQI(~~J I PACE ~ - - _ ~ :a; ~ . , r - ,a- > f . ~ ' - ~ = ~.c~~