Nome of Mothe~ Birth Place

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Date of Birth

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PClge No.

aREAl GRANDMOTHER

Name

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J

Name
Birth Plcce

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_

Birth Place' Date of Birth

Deceased _

_ _

Dote af Birth Deceased __

01

_
_

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Na~e

of Spouse

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Name of Spous.e 8irth Place

Dole of 8irth

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_

Deceased

Date

of MOrriOge-'4.4~<....:'d':......!:..V--' .. ~-=~~7f__L __(/.....:i?:.........J~L<'£==~

Date of Morrioge ot

_ ___

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CHILDREN

CHit D REN

Page

No.

10

11

Heme

lleXdAJiJ/,
So

Birth Place

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Dote of Birth ~. Deceo,ed

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Harne of Spouse Birth Place

Dote of Birth

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12

13

__________________

Pag. No.__

MOTHER'S GREAT GRANDMOTHER

MOTHER'S GREA~\GRANDFATHEI

1:2 t.;;;P S4/!!

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MOTHER'S GREAT GRANDMOTHER

Birth Ploce __ Date of Birth Deceased

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Name of Spouse

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Dote of Bir,h

Birth Place
Date of Birth Deceased

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01

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Date of Marriage at

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Date of Morrioge

Page

--L
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No_

18

19

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Nome

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Birth Place ---------------

DGte of Birth

Birth Place Date of Birth

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01

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Birth Place ------------------

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Dote of Birth

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Date of Marriage

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CHILDREN
1'Dg. No.

CHILDREN

20

21

How Related

Birth Place Date of Birth,----:Deceased

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Deceased

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NameofSpouse Birth Place Date of Birth Deceased at

Name of Spouse
Birth Place

Date of 6irth _

Dq,te of Marriage at,

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__

Date of Morrioge----------------------at __

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CHILDREN

P"IiI. No.

Page No.

22

23

Name How

Relo,e/Eller t 1n;Z~tdfrelytr;drr~l?inI-WL
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Poge No. _

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I,

Birth Ploce

Date of Birth -~~--~~~~----~--~

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Date of Birth

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Date of Binh -

at _~

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01

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CHILDREN

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CHILDREN

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No.

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24

25

Pag~ No.M Birth Ploce

Date of 8irth _ ct _

Nome

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How Related

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Page No.Lfl.
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Birth Plac:e
DQt~ of Bir'"

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_

Dececsed

Deceased

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Name oi Spous.e _..L.t..:..../...;...J'Iu..._._c-'/:..:~_'_"J~ ..... LJ__..a:.V'......:~~p:..::;t'...:.r------Birth Place

I

Name of Spouse Birth Place Dal. of

_.u.of~"CL.L.0_11f~-Sa.s.:l..).jLw~u~c:-------_
_

Dececsed

at

De(:eosed

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_ __

Date of Marri a9~ 01

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Date of Marriage _ 01

Jie, &/lesT

CHILDREN

Paille No.

26

27

Name

1L1lz.«S

How RelatetL Birth Plece __

Date of Birth

/J1o tiP r 1 h;;iI~c

---:I /

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Page

No.Ld:
_

"

J:i / i .;:z. tJ 8'S t" DeceoseklJ( lair at

Birth P1oce Date of Bil1h Deceosed -:--_--,--

Birth Pldce-~___;___r------------Dote of Birth

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_

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Deceased

del: I~. 1S-8tf t a

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_

18' 52

.I

1.1

Nome of Spouse

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at

Birth Pface
Dote of Birth Deceased

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_

Date of Morriage

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em be r

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Date of Marriage

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CHILDREN

..... " No.

:
I

28

29

Name

GCc.l..'e. A Ita e.
h1lK r () e
! so

How Related Birth Place Date of Birth Deceased

s/ S fE'r

1St:.'lliJ!'"'

Page No.k_

Nome How bloted Birth Place Date M Birth

Page No._

at

Deceased

ot

Name of Spouse Birth Ploce Date of Birthl4l4t1

r: #';,$/ d.r
U

Name of Spouse Birth Place

Date of Birth Deceased 01

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)3'~5
at

Deceased

! \
Date of Marriage at

Dote (If Marriage at

q
CHILDREN

P4I". No.

t•

CHILDREN

Pag_

No.

~--

LtJuis

·.1
30

31