,FREDERICK TOWN OF PALM BEACH SMITH,PAGE W BURT,OLIVER TURKLITZ,GERTRUD

ur spouse lived together as husband and wife. (day/ month/ yeas) If relying on any period outlined here as pan of the 12 months separation, go to Page G — Ditanzla 18. Do you think it is likely that you and your spouse will live together again as husband and wife? If yes, go to Page G -Darn fa 19

and wife? If yes, go to Page G -Dine 1Gt 19. At the date of filing this application, is it less than two years since you married? If yes, go to Page G —Dizave Date 3D / 3 / icielb * Town/city County Husband Oetafteb$ cserms Mt 6‘eat-'‘i Cr Wife *5-Fic-civeLicie cecta Pet ace Date ) / 3 / 2