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No. 5078398 Name SMYRSKI, Rozalia residing at RFD #1, Box 3, New Milford, Conn. Age 46 years. Date of order of admission May 19th, 1942 Date certificate issued May 19th, 1942 by the Superior Court at Winsted, Connecticut. Petition No. 4805 Roxalia (Complete and SmyroJar true signature of holder) AR No. 1735045

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