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R. No. 7968274
Name KLIMKOSKI, Theodosia
residing at
31 Fairview St., Terryville, Connecticut
Date of birthune 7,1880 7, Date of order of admission Feb.18, 1960
Date certificate issued
February 18, 1960
by the
Superior
Court at Litchfield, Connecticut
Petition No. 7239
Alien Registration No. 1 401 004
Theoolosia Keinihorki
(COMPLETE AND TRUE SIGNATURE OF HOLDER)
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