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FORM′D' / TT町`I,

M各MORANDUM OF MA師iAG各

判 節喝青和げ
│SeeSection6andrule5 / 'JF河。 9^ i tァ@

._曲 ¥ノ

討手古壷可
之楽器罵蕊器cし刷 圏星団因
3. pe「soli∂=aw∂c⊂o「di噂to wh ch亡he

蒜葉書%n tie p=w#nlzed


fa’清浄臼:丁同前両町

4. DetailsofHusband /羽前di qTen

a) :,霊'霊.mD:n°df浬「 丘亜一
博inc

書`giv 哩票-一塗し` qrq’

b) Other Name/s (陸nv) W吊chthe

husband known
q7病「 FT′隔宙(前諒3wan)
謡-あ耐3押irm a in /市nd

cl Rel嶋ion(I)ByB而h .・三園_..._H'`読u -. M.a洞塙o__臆

(ii) By adoption (if any)


阜r J「i l¥.羽T...-
轟く9)市布
は) gr両前珊和訳向n (前面博聞FT) :

d) Age as on the dateof : Years. Mo両s

器晋,:O#r, ネ ヨ奉 峰ナ 麪
日面丁壷e軒「 ch :’JTH* ap

e) 0〔cupationalo噂with

O箱ce addre55.

詞和昭.冊rぐ柵珊q市棚?

f) 5ta[usa[thetimeofmariiage Unmarried / Wid


后揃r9ir示7前脚
寓弼圏
g) F捕るdd「e55 o白he hu5b∂nd
晴rr油井qi耐

h) Signet.ure of the Husband


lv而da亡e
鮭/ 議`aT `±¥,:

c言, :主,.i7.-:{TrE翻.Ta

b) o章。e川合me§/s(if8n∨) bv
whic吊he wife is known

票語捕る-和, I
c) Re。g,.n(i)B,B,,,h i討ノ-巧くTZT

壷((;,))#option(ifany) H`晶, -n如r¥ha


(3)印南t± 3珊可「碍(両町耐3河i抑) :

d) Age65on章hedateof
:..._q工」__._... Vears 6 M°nths

Soiem面zatio寄of ma「「iage

高崎命甫可「 aTdr和子 :_詩±垂T


耶打電粛軍打南3?浦珂
e) Statusatthe 〔Imeofma「「ia官e u3n#d ,/鐸薯若
ra-qi引t4i三馬前fan

f) Fu= address of the wife before ¥」 l

of at the timeofmarriage 挿く,永島, <ha


寮持- aian
g) Signeture of the wife.with date
揃aTTa蕪河●肘

6. Witness /珊掃打て

1) i) Name

隅 @ F5]聞
ill) Occupation andoffjce address : 」蛙馳i笠二農,イ

-阿珊電柵qaIT ,輸_亜_
iv川e部on (if綱引

的両端ffla(壷c冊u)肥
v) Signature with date
aT義昭牢雨h
I’ii) Occupation and office address
紫雲窯三三
----」`=,鴎i臆・ --.L占島㌻
奇骨郁可3Tr市岡壷専可「可門前 -..-..--..式式¥’’’-’i叫 〔

iv)菩謙一蕊悪捕面詰請「・.-、事*薫

iv罵忠恕ふ前曲
∨) 5ignatu「e面th date

百前頭南n
riest/車軸
a,露器'1est
b)手u= Addi"ess
圏圏藍監蓋謹萱
町中7Tan

卵e匝「. 1壷
_二二二二二9-.q∴--- ----i--....---
d,A.ge / qq

e,謀議date

3,榊T、 G)
..,疎的和狙ut / q甲±.ffim n康両晒(相聞at an)

N.a. :Ar`v person makirtg ar¥ystatement ordeclaratlon in the nieinorandum wliich i` t ,I.`L` ‘,, , ni`iterial pa,`.c.`,I., ';

submits any docurnenls whlch he/she known or has reason to bellt!veto be false s剛.e I.ii,正or penal actioi同r``je.

5ectlon12
f討: ft吋聞古r「叩m雨竜討finf討所uirm*拭き3Tおrm同7rt示F,.i , uiq両杯T耐, , r,
珊中古利和/f,印叩向3T雨3同a雨!叩T丙汀訂rm仰T 肌X鹵ニ遅 坪ヒ謦 ツニ ナイテ メ 簫 菟
耐雨tm*1
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匿馬蹄営e垣骨宮l二世p産声布陣[±
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