What do I write?

Kathryn Anne Jeffries

I think this is the event place for a Declaration of Intention. I can't read the first word on the second line, what should I write?

Tom123

In the General Instructions for all project, it tells you if you cannot read a word to write the letters you can read and put a ? mark on a letter you cannot read or if it is more than 1 letter in a row to put an * mark. ( Ex: *st)