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T No. 3405689 Name CORNELIO, Thomas Gaetano residing at 14 Corndio Avenue, Winsted, Conn. Age 34 years. Date of order of admission Jan. 5, 1932 Date certificate issued Jan. 5, 1932 by the Superior Court at Winsted Petition No. 2989 Thomas Goetano Cornelia (Complete and true signature of holder)

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