CO129-466 - Individuals - 1920 — Page 164

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COPY

HONG KONG Stamp Duty

$3.00 22.9.17.

I, CHARLES WILLIAM FALK of Victoria in the Colony of

Hong Kong a Master Mariner solemnly and sincerely declare

and say as follows

162

1. ON the 20th day of September 1917 I signed the Memorial and Humble Petition for a Certificate of Imperial

Naturalisation which is annexed hereto.

2. The statements cobtained therein are true and

correct in every particular.

AND

I make this solemn declaration conscientiously

beliefing the same to be true and by virtue of the provisions of the Statutory Declarations Act 1835.

DECLARED

at Victoria this } 20th day of September 1917 )

( sa )

C.W.FALK

Before me,

(Sd)

E.J.GRIST

Notary Public.

Hong Kong