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No. 7571311 Name SZEWCZAK, Edmund residing at 663 Myrtle St., New Britain, Conn. Date of birth 1/10/24 Date of order of admission 9/24/59 Date certificate issued September 24, 1959 by the Superior Court at New Britain Petition No. 6197 Alien Registration No. A8 700 620 Elmund Sewczek (Complete and true signature of holder)

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Document identity
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