TRANSLATION.
TON TO BE SUPPLIED BY APPLICANTS FOR DENATIONALIZATION
CERTIFICATES.
80
Name of applicant
Age of applicant
Address of applicant
Place of birth of applicant province---district---locality---
Name of great grandfather
Name of grandfather
Name of father
Maiden name of mother
Maiden name of wifo
village
whother
whether living or dead
Names of song
Names of daughters
Locality of immovable property
Business in the interior
whether married or single
---
9g08---
occupations
whether in treaty ports or in the interior-position should be described in detail.
namo of established ners exist.
where conducted
whon
whether or not part-
Business commections and assets in treaty norts
Name of country nationality of which it is desired to adopt
Reasons for changing nationality
Signature and seal of applicant Date