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C-lj-l
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venile"- j □Parente ’. _ ? "Name (Last)" j Local Custodiari* * . j Otner:-?.' ?‘ ..'./ ... -(FirslXj Residenee/pnone . | 1- ) 7 | Address UJ I . . _ (C-lj-l (Siatel" •' ■ ,<Zip) Business Phono . 1 .. 1’ 2 tot/jac*.. ----- Date; Time' |‘ School Attended ’ ; Grade. ’ST The above address wasjxovided by E) de
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