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Witnesses:                   

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Immigrant ID:                
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:                CALA-15MAY1921-3-16-0005 
Birth Place:                 

Bride Father Name:           
Immigrant ID:                RUGI-22SEP1892-3--0353 LBRT-18DEC1905-3-28-0030 
Birth Place:                 

Bride Mother Name:           
Immigrant ID:                PHIL-25APR1908-3-C2-0006 
Birth Place:                 


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