H 12817 % 700 שנת 23A 19 6 Name and Surname of Father and Mother ביום 4. לחיס 7 Calling of Father and Mother 8 Residence of Father and

Husband 13 אייר האשה 7122-12817 25 Certified that the above is a true extract from the Register of Marriages kept at the office of in the District