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For the Secretary of State for War only. . W.O- Form 350-
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STATEMENT of the Services ofr>42e:' 7 ' a4>%a of tl1ey?"(%‘0’7 Regiment of 5 ..:..nWith 51 Re001‘d 0fS110hPaTtiC11131'S
as may be useful in case of his Death. "
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If “'9 0mm" b9 M““'ied2 5P‘3”if)’ If the Ofiicer has my legitimate Chhdren. specify - Ye“,
- W Mnismmm ‘ n"?:“““" Service on I do hereby certify, upon my honour, that to the best of my
W1: “'1: T h 1'T‘hL “:15 Mam1‘d the M" mm
en ere n w om Mug a ne , N ‘I . A . A ‘ , . .
Dam of Purtxcs, nud of mes of Birth Baptized I In " hehef, ' “ "‘ "" A ‘ ‘ 1 true.
what Church
a?Z71,4g OKXZT’ Signature of the Ojicer.
hVe do hereby certify, that ‘Ve are satisfied of the general
t correctness of this statement.
<:.%m.,., " " , Omcer.
O%% gyzfa Paymastcr.
M >f:x)’5Adjutant.
Dated at tlL1's‘,,,:day J:”186 .
' Non.-A Report is to he nnule to the “'nreOHiue within six month:
of the 1IDl‘)'illgC.’SL‘! 1h'y1tIatImIt or Il'z'dam’I’rmio1I.9,
ILA: T. 2300 3-50.
