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No. 6051668 Name GODBOUT, Marie Jeanne residing at 215 Main St., Winsted, Connecticut Age 32 years. Date of order of admission May 16th, 1944 Date certificate issued May 16th, 1944 by the Superior Court at Winsted, Connecticut. Petition No. 5715 Marie-Jeanne (Complete and true signature Godbout of holder)

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