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R. No. 8573074 Name JAKIMENKO, TATJANA residing at 50 Elmira Avenue, Torrington, Conn. Date of birth Jan. 21, 1921 Date of order of admission Feb. 9, 1967 Date certificate issued February 9, 1967 by the Superior Litchfield, Conn. Court at Petition No. 7673 Alien Registration No. A10 941 577 Jatjana JaRimenRo (COMPLETE AND TRUE SIGNATURE OF HOLDER)

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