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Dist. 110:210 t Cot" 770044.4,44/
111:11.1age 4499.1ta;:settee, &WO)
Viatne. of deceaseki. .. ........ `144/cov 4€1........ .
ci.Aticteyt tY .....
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Age... ... ........................................ . ......,ays
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Gettificate egas signed ....... . . .... . .. . ......... 67. . . . ...........................
pate
Address................ .. . . .. . ••• ..• -• .
'Place of Itnital ••
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The Cettfleitte OT westb containing clic 5tt
na • acing to be COWL. , CO:WYRi istAX:0131 itt., the above stated
too the cattle 244"` e for reitstr tion, Tartrice"p,1450/11
boe a rant e 7;0
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Number o . ....................
.........1164 tenivocati •kiptes,oee,0 .et .. . ..... ......... .
tbe........ • ee 0e ve eo ibus easyse
Dated.. .. (Signe()) nes
This Permit se sufflcipnt fo"r. Woo.at Caria toterolc:TyriCerintrbialtitnet bliciltst:sirtio:V;t&IStill'IoSts. fate) irrette:Int
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