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No. 7566271 Name SKRZYPCZAK, Joseph Henry residing at 68 Dobek Road, New Britain, Conn. Date of birth 8/22/24 Date of order of admission 9/24/57 Date certificate issued September 24, 1957 by the Superior Court at New Britain Petition No. 5796 Alien Registration No. A8 206 701 Joseph then y Harsy perak (Complete true signature of holder)

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