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No. 8481672 Name SZACH, Danuta residing at 11 Beatty Street, New Britain, Conn. Date of birth 6/4/46 Date of order of admission 4/14/64 Date certificate issued Apr il 14, 1964 by the Superior Court at New Britain Petition No. 6934 Alien Registration NoA8 441 610 Danuta (COMPLETE AND TRUE Syach SIGNATURE OF HOLDER)

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