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Witnesses:                   

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Age:                          years 
Birth Date:                  
Occupation:                  
Marital Status:              
Home Address:                
Birth Place:                 

Bride Name:                  
Immigrant ID:                
Age:                          years 
Birth Date:                  
Occupation:                  
Marital Status:              
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Groom Father Name:           
Immigrant ID:                
Birth Place:                 

Groom Mother Name:           
Immigrant ID:                LSVO-11OCT1913-3-14-0014 
Birth Place:                 

Bride Father Name:           
Immigrant ID:                LSVO-27JUN1903-3-AA-0013 LTRN-02JUL1911-3-3-0025 
Birth Place:                 

Bride Mother Name:           
Immigrant ID:                STLO-08JUL1912-3-C8-0018 
Birth Place:                 


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