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[[preprinted]] 100 [[/preprinted]]

[[check mark]] [Under. Okoman omah, No komayeg]


[[scribbled over following:]]
F. N'zhih grois 
M. Nno sha

[[large square bracket]][[check mark]] Aunt (father's side) Nzih grois

[[check mark]] Aunt (on mother's side) N'no sha
[[/large square bracket]]