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Firm 3HII 1645236 36 Age Name John Paul Kushis 25 years Declaration No 8636 isseed by Clerked Superior Court of workster County mass on the Perition, Vil. XI 2620 24 day of may ,9.1915 the 16 day,of September 19.19 21 Name age und place ofroidente afuile single Names ages, and plum of residence of minor children none John Paul theasis John Paul Signature of holder.) Kuelis New Oll No

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