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No. 5378506
Name FOULOIS, Agnes Josephine
residing at Washington Depot, Connecticut
Age 30 years. Date of order of admission May 18th, 1943
Date certificate issued
May 18th, 1943
by the
Superior
Court at
Winsted, Connecticut.
Petition No. 5118
agnes Josephine Complete true signature Foulois of holder)
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